ABSTRACT: Atrophic acne scars are a common sequela of acne vulgaris and can impose a substantial cosmetic and psychosocial burden. Several treatment modalities are available, including chemical peels and microneedling; however, no single gold-standard treatment has been established. Combination approaches have been proposed to enhance treatment outcomes by targeting multiple mechanisms involved in dermal remodelling. This study aimed to compare the efficacy and safety of microneedling alone, Modified Jessner’s Solution alone, and their combination in the treatment of atrophic acne scars among patients with Fitzpatrick skin types III–V. This randomised controlled study included Filipino patients aged 18–45 years with clinically diagnosed atrophic acne scars assessed using the Global Acne Scarring Grading System (GASGS). Participants were randomly assigned to three treatment groups: chemical peeling (CP), microneedling (MN), or combination therapy (MC). Treatments were administered at Weeks 0, 4, and 8, with follow-up at Week 12. Outcomes were assessed using the GASGS based on standardised clinical photographs evaluated by blinded dermatologists, as well as the Facial Acne Scar Quality of Life (FASQoL) questionnaire. Fifty-five participants completed the study: 18 in the CP group, 17 in the MN group, and 20 in the MC group. Median quantitative GASGS scores decreased progressively across all treatment groups over the 12-week study period, indicating improvement in acne scarring from baseline. The CP group demonstrated a less pronounced reduction by Week 12 compared with the MN and MC groups, although no intervention demonstrated consistent superiority. All procedures were well tolerated, with mild and transient adverse events reported. Quality-of-life scores improved across all treatment groups. Microneedling, Modified Jessner’s Solution, and their combination were well tolerated and showed potential for improving atrophic acne scars among patients with Fitzpatrick skin types III–V. Combination therapy may offer additional benefits over either modality alone.