INTRODUCTION: Topical insulin (TI) has been shown to enhance wound healing by promoting re-epithelialization and collagen synthesis. However, there have been limited studies addressing its potential use in treating acne scars. OBJECTIVES: To assess the efficacy of combining TI with microneedle fractional radiofrequency (MFR) in the treatment of atrophic acne scars. MATERIALS AND METHOD: A split-face, double-blinded, placebo-controlled trial involved 30 participants with atrophic acne scars. Each side of the participants' face was randomly treated with a combination of MFR and TI or a placebo every 4 weeks for four consecutive sessions. RESULTS: Significant improvements in scar volume were observed, with statistical significance at week 12 for MFR combined with TI sides (baseline 18.22 ± 9.86 vs. 16.20 ± 8.58 mm CONCLUSION: Combining topical insulin with MFR is safe and could accelerate the early acne scar improvement.