Objective To compare the effects of fractional CO2 laser and gold microneedle on scar improvement in patients with facial atrophic acne scar. Methods A total of 84 patients with facial atrophic acne scar admitted to the Department of Dermatology of Changshu Ruili Mebel Hospital from February 2023 to February 2025 were selected. According to the random number table method, they were divided into the control group (n=42) and the observation group (n=42). The control group was treated with fractional CO2 laser, and the observation group was treated with gold microneedle. The scar improvement, key time-effect parameters, treatment effect and adverse reactions were compared between the two groups. Results After treatment, the ECCA score of the observation group was lower than that of the control group (P<0.05). The inffammatory exudation time, erythema duration, decrustation time and wound healing time in the observation group were shorter than those in the control group (P<0.05). The total effective rate of the observation group was 95.24%, which was higher than 80.95% of the control group (P<0.05). The incidence of adverse reactions in the observation group was 7.14%, which was lower than 28.57% in the control group (P<0.05). Conclusion Both fractional CO2 laser and gold microneedle show good treatment effects in the clinical treatment of facial atrophic acne scar. However, gold microneedle has better efffcacy in improving acne scar, along with the characteristics of shorter postoperative recovery period and lower incidence of side effects, which is worthy of clinical application.