Background Efficacy and safety of ablative fractional laser used for treatment of acne scars have been described in several studies. Recently, microneedling radiofrequency treatment has been showing promising results with low risk of side effects and rapid healing time. Objective To study efficacy and safety of ablative fractional Er:YAG laser 2940 nm and microneedling radiofrequency for facial atrophic acne scar. Methods 21 patients with atrophic postacne scars were randomized to MRF for one half of the face and laser for the other half. Four sessions were performed monthly. For evaluation, the validated scale “Quantitative Global Grading System for Postacne Scarring” and patient's satisfaction were used before and 3 months after treatment. Optical coherence tomography imaging of the skin was used as an objective tool for assessment. Results Both sides showed significant improvement on clinical evaluation with no significant difference. Optical coherence tomography assessment showed significant increase of both epidermal and dermal thickness compared to baseline. Conclusion Both MRF and ablative fractional Er. YAG laser 2940 nm are effective in the treatment of post acne scars. Microneedling radiofrequency is better tolerated, with lower downtime and fewer side effects.