Acne scars represent an entirely highly challenging frustrating clinical problem. Various modalities and protocols were suggested. Fractional CO2 laser has proved marked improvement in scars. On the other hand, fat grafing as well proved its efficacy recently in regenerative medicine. A comparison between fractional CO2 laser and fat grafting in treatment of acne scars was needed to help treatment of such condition. Twenty patients were presented in this study. Ten patients were subjected to 3 sessions of fractional CO2 laser. The other 10 patients were subjected to fat grafting. All patients were followed up till 3 months after the last session. They were assessed by digital photographs by 3 physicians, single blinded physician and patient satisfaction. In the laser group, less than 20% of patients graded as excellent, 0% as marked, less than 10% as mild with almost 70% as moderate scar improvement. On the other hand, among the fat graft group, the scar and overall improvement were graded to be 30% as excellent, 30% as marked, 20% as moderate and 20% as mild. In conclusion, fat grafting proved to be more effective in treatment of acne scars when compared to ablative fractional CO2 laser. Many points were in favor of the fat graft if one gets to choose between the two procedures, on top of all was the clinical improvement in scars and texture. This supports the stem cell theory of adipose tissue in regenerative medicine.