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.