Objective To explore the efficacy and safety of PRP combined with derma rolling in the treatment of facial scar. Methods A total of 50 patients with facial scar admitted to the Department of Burn and Plastic Surgery, the 960th Hospital of the People's Liberation Army from January 2023 to May 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 25 patients in each group. The control group was treated with CO2 fractional laser, and the observation group was treated with derma rolling combined with PRP. The clinical efficacy, scar improvement and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (100.00%) was higher than that in the control group (84.00%) (P <0.05). The scores of ECCA and GAIS in the observation group after treatment were better than those in the control group (P <0.05). The incidence of adverse reactions in the observation group (4.00%) was lower than that in the control group (24.00%) (P <0.05). Conclusion The effect of derma rolling combined with PRP in the treatment of facial scar is definite, which can accelerate scar improvement and reduce the incidence of adverse reactions during treatment.