Objective To investigate the effect of intensive pulsed light combined with CO2 fractional laser in the treatment of skin photoaging. Methods A total of 78 patients with skin photoaging admitted to the Department of Cosmetic Dermatology, Xuzhou Huamei Beauty Hospital from May 2022 to February 2024 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 39 patients in each group. The control group was treated with intensive pulsed light, and the observation group was treated with intensive pulsed light combined with CO2 fractional laser. The clinical efficacy skin condition and adverse reactions improvement of the two groups were compared. Results The total effective rate of treatment in the observation group was 97.44%, which was higher than 82.05% in the control group, and the difference was statistically significant (P <0.05). After treatment, the GAIS score of the observation group was higher than that of the control group, and the GSP score was lower than that of the control group, the differences were statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Intensive pulsed light combined with CO2 fractional laser is effective in the treatment of skin photoaging, which can effectively improve the skin condition of patients without increasing the incidence of adverse reactions, and is worthy of clinical application.