Objective To explore the effect of CO2 fractional laser combined with recombinant bovine basic fibroblast growth factor in the treatment of facial skin aging. Methods A total of 86 patients with facial skin aging admitted to Yangzhou Jiangdu Maternal and Child Health Hospital from January 2021 to December 2023 were selected as the research objects. According to different treatment methods, they were divided into reference group (n =43) and experimental group (n =43). The reference group was treated with CO2 fractional laser, and the experimental group was treated with CO2 fractional laser combined with recombinant bovine basic fibroblast growth factor. The clinical efficacy, skin barrier function, adverse reactions and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the experimental group was 97.67%, which was higher than 86.72% in the reference group, and the difference was statistically significant (P <0.05). After treatment, the skin water content and percutaneous water loss in the experimental group were better than those in the reference group, and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the experimental group was 0, which was lower than 9.30% in the reference group, and the difference was statistically significant (P >0.05). The treatment satisfaction of the experimental group was 100.00%, which was higher than 88.37% of the reference group, and the difference was statistically significant (P <0.05). Conclusion C O2 fractional laser combined with recombinant bovine basic fibroblast growth factor is effective in the treatment of facial skin aging patients, which can effectively improve the skin barrier function of patients. Meanwhile, it can reduce the incidence of adverse reactions, and is conducive to improving treatment satisfaction, which is worthy of clinical application.