Introduction: Acne is one of the most common disorders. Quite often, acne results in scar formation due to the preceding inflammation causing either loss or gain of tissue. Ablative CO2 laser resurfacing and microneedling are proven effective modalities for the treatment of acne scarring. However, one out of two techniques is done exclusively in a patient. In the present study we have compared the sequential usage of CO2 laser + Microneedling Versus Only CO2 laser. Materials and Methods: A total of 50 patients were recruited for the study. 25 patients with moderate-to-severe acne scars underwent one sitting of fractional CO2 laser, followed by Microneedling after 3 weeks to follow the same sequence making total of four sittings over 6 months, while other 25 patients underwent total of four fractional CO2 laser sittings within a gap of 3 weeks each. Outcomes were based on GoodmanÂ’s Qualitative and Quantitative assessment. Results: Acne scarring improved significantly in all the 50 patients. Mean scar scores decreased to 9.05% as compared to 58.52% before treatment, decreasing by a mean of 49.47% in Group A, while in Group B, the mean scar scores decreased to 7.45% as compared to 30.20%, decreasing by a mean of 22.75%. Based on quantitative assessment of after treatment reduction of Acne Scars Comparing Group A and Group B. Very good reduction of acne scars was found in 2 (8%) patients in the Group A whereas in the Group B none of the patients had found the very good reduction. Good reduction of Acne scars was found to be in 12 patients (48%) in the Group A, whereas in the Group B was found in the 3 patients (12%), moderate reduction was found in the 10 patients (40%) in the Group A whereas in the group B had found in the 15patients (60%). It was found to be statistically significant association (P value= 0.001). This infers, maximum good reduction was found to be in association with the Group A than Group B. In the Group A, all the 25 patients presented with erythema, edema, needle impression and all the 25 patients in the Group B presented with the erythema respectively Conclusion: The use of combination therapy of CO2 laser + Microneedling and CO2 laser is more efficacious than CO2 laser alone. This combination present with more or less similar side effects as compared to monotherapy.