Abstract Background: Acne scars are one of the most common cosmetic concerns causing psy- chosocial distress. Objective: To evaluate the efficacy of subcision versus its combination with either cross- linked hyaluronic acid (HA) or poly- l- lactic acid (PLLA) threads in the treatment of atrophic post- acne scars. Methods: Forty patients of both genders with atrophic acne scars were subjected to subcision 1 month apart for 3 sessions. After the last session of subcision, the patients were reclassified randomly into 2 equal groups each received either HA or threads in one side of the face leaving the other side that underwent subcision before as a con- trol. Clinical assessment was carried out by the physicians and patients. Photographs and skin biopsies were obtained. Follow- up was 6 months. Results: A significant clinical improvement was achieved in 67.3% of patients after subcision alone compared to 94.1%, 82.4% of subcision combined with HA or threads, respectively. Patients’ satisfaction was higher in the combined groups compared to subcision alone (p < 0.0001). Side effects were tolerable and transient. Conclusion: Subcision combined with HA or threads could offer a higher significant clinical improvement of acne scars than subcision alon