Derma roller vs CO2 laser resurfacing for acne scars?

I have used both techniques but find the roller to be somewhat barbaric. I usually recommend subcision/excision of scars followed by ablative fractional resurfacing. I like the 2790 nm system or a CO2 system. Not all lasers are created equally and not all users are experienced with lasers. Acne scarring is challenging to treat. I do a lot of this in my practice and feel that there is a great deal of nuance and expertise required to treat this condition safely and effectively. Buyer beware!

Acne scarring is difficult to treat. Both modalities involve dermal scarring and collagen regrowth to help even out skin appearance. Side effects are similar in either case.

If the cost is the same, I would recommend the CO2.  I typically do the fractionated CO2 procedure with sedation and tend to be more aggressive with the treatment to the point where I don't necessarily recommend a series of treatments.  The decision is largely driven by my patient's ability to manage the downtime.  The more aggressive the treatment, the longer the redness can persist.

In my office, we use the fractional co2 laser to improve scars that have a textural component. Raffy Karamanoukian Los Angeles

Acne scars can be a frustrating problem for both the surgeon and the patient. Different types of scarring will respond differently to therapy. I have found that the derma roller or Roll-Cit works well on acne scars. It punctures the skin multiple times with tiny needles. It is a very painful procedure and I usually do it in the operating room under anesthesia.
I have found that a single therapy is adequate and down time is about 6 days. Your face will look swollen, really swollen, and quite messy until it is healed. The technique works best on shallow acne scars rather than the deep ice pick scars. Ice pick scars will do better with punch excision. I have been using the Deep FX CO2 laser for acne scars lately and I like the results. We do it in the office. Healing takes about 5 days.
Once again, it works best on shallow scars rather than deep pits. One treatment is adequate as well. I wouldn't combine the two therapies at the same session. Both treatments last about a year, meaning that over time some of scarring will become visible again, and the results should not be considered permanent. With both treatments I have not had any issues with pigment change. I have used the ROLL CIT in patients of darker skin type and they have done well. I hope this helps.

Both treatments induce injury to the dermis so that a repair mechanism results. New collagen is deposited in the areas of the microholes. This new inflammatory process, may help raise depressed scars. The combination of these two treatments, might increase the risk of scarring compared to the risk of each procedure when done separately. Dermaroller treatment has not been studied nearly as throughly as Fraxel!

Microneedling is best for milder
scars.
A dermaroller or other microneedling treatment can improve the appearance of
shallow, diffuse acne scarring along with improving all-over skin tone and
texture. For very deep acne scars, I would recommend combining microneedling
with another treatment such as dermal fillers, laser resurfacing or scar
treatment, including scar excision. In some cases, combining microneedling with
a regimen of other procedures may give you the best results. Since some of the
treatments you’ve tried already are actually more aggressive than
microneedling, I’m not sure you’ll get the results you hope for from a
dermaroller.

Alishba,

Good question. Managing of deep acne scars can be a difficult problem. In our practice we utilize both the dermal roller in combination with fractionated laser resurfacing to manage a plethora of scarring, including deep ance scars and stretch marks.  The treatments are performed independently of one another, typically months apart. This, done, in combination with an oral and topical skincare regimen, offers superior results as compared to performing either procedure independently. In people with darker skin types, care must be taken to avoid hypo and hyper-pigmentation sequelae. Subsequently, while I would prefer to utilized a fractionated CO2 laser, and notably the Lumenis Total FX, in such cases, I defer the laser treatment to the Fraxel Re:Store. Although more treatments are necessary with this laser, in my hands it has proven to be safer in darker skin types while offering near-comparable results. Price points are relatively the same for both laser.

Regards,

Glenn Vallecillos, MD, FACS

Diplomate, American Board of Plastic Surgery

Beverly Hills, California

....CO2 denatures collagen- this is the advantage over skin needling. Denaturing of collagen is essential in scar remodelling. Additionally the coverage, depth is more precise with a laser. As for pain, using a 23/7 lidocaine tetracaine, plus local anaethesia to deeper areas should be adequate. As for side effects, CO2 will give more chances of PIH or post laser darkening, but once again this depends on the laser provider and your skin type. RegardsDr Davin LimCosmetic and Laser Dermatologist, BRISBANE, AUSTRALIA