To analyze the efficacy and safety of ultra pulsed CO2 fractional laser in the treatment of atrophic scars. Methods A total of 60 patients with atrophic scar admitted to our hospital from January to December 2022 were randomly divided into control group and intervention group, with 30 patients in each group. The control group was treated with conventional drugs, and the intervention group was treated with ultra pulsed CO2 fractional laser. The clinical efficacy, psychological status, scar degree, adverse reactions and quality of life were compared between the two groups. Results The total effective rate of treatment in the intervention group was 96.67%, which was higher than 56.67% in the control group (P <0.05). After treatment, the HAMD score and HAMA score of the two groups were lower than those before treatment, and the intervention group was lower than the control group (P <0.05). After treatment, the ECCA score of the two groups was lower than that before treatment, and that in the intervention group was lower than that in the control group (P <0.05). The incidence of acne-like rash in the intervention group was lower than that in the control group, and the incidence of punctate bleeding, burning sensation and pain was higher than that in the control group (P <0.05). There was no significant difference in the incidence of pigmentation between the two groups (P >0.05). After treatment, the scores of physical function, psychological function, material life and social function in the two groups were higher than those before treatment, and those in the intervention group were higher than those in the control group (P <0.05). Conclusion Ultra pulsed CO2 fractional laser is effective in the treatment of atrophic scars, which can effectively improve the psychological status, reduce the severity of scars, and improve the quality of life of patients.