Background: Acne is the most common skin disease affecting adolescents and young adults, with associated scarring and its sequelae. Treatment options are either lifting procedures raising scar base closer to normal skin surface, or resurfacing ones injuring epidermis and superficial dermis with neocollagenesis and epidermal repair. Punch elevation (PE) method is better for improving deep atrophic acne scars, that can be combined with depth resurfacing. CO2 laser stimulates new collagen formation, tightens skin and raises scar to surface. Aim of the Work: to assess efficacy and safety of combination of PE technique and fractional co2 laser (Fr co2 L) compared to fr co2 L alone. Subjects and Methods: 20 atrophic post acne scars patients were subjected to history taking, general and dermatological examinations, identifying scars types and grades. Treatment response at start, before each fr. co2 L session and 4 weeks after last laser session was clinically evaluated by Goodman and Baron scale, and recording patients' photographs, satisfaction, and complications. Histopathological examination of scar skin biopsies before and 4 weeks after the last fr. co2 L session was done using H&E, Mallory trichome, sliver stain and immunohistochemical VEGF. Results: combined treatment with fr co2 L and PE was more effective in improving post acne scars than fr. co2 L resurfacing alone. Histopathological examination before combined fr. co2 L and PE treatment and 1 month after the last fr. co2 L session showed high significant increase in epidermal thickness (H&E), increase in collagen fiber type III (Mallory trichrome stain), decrease in collagen fiber type I (sliver stain) and increase in fibroblasts' activity (VEGF). Conclusion: both PE technique and fr. co2 L resurfacing show promising efficacy and safety in treating atrophic post acne scars, complementing each other to improve skin texture and appearance, with excellent cosmetic outcomes.