Objective To observe the clinical effect of ultra-pulsed CO2 fractional laser combined with medical cold compress on facial acne depressed scars. Methods From October 2021 to December 2022, 80 patients with facial acne depressed scars admitted to the Department of Medical Cosmetology, the Fifth People's Hospital of Hainan Province were selected as the research objects. They were divided into observation group and control group by random number table method, with 40 patients in each group. The control group was treated with CO2 fractional laser, and the observation group was treated with medical cold compress on the basis of the control group. The clinical efficacy, incidence of adverse reactions and acne scar score were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.00%, which was higher than 72.50% in the control group (P <0.05). The incidence of adverse reactions in the observation group was 5.00%, which was lower than 22.50% in the control group (P <0.05). The acne scar score of the observation group was (25.67±2.85) scores, which was lower than (29.38±2.46) scores of the control group (P <0.05). Conclusion Ultra-pulsed CO2 fractional laser combined with medical cold compress can improve the clinical efficacy of patients with facial acne depressed scars, reduce adverse reactions and improve acne scars.