Objective To explore the effect of micro-focused ultrasound technology combined with fractional laser in facial skin anti-aging. Methods A total of 66 patients who received facial skin anti-aging treatment in Binzhou Central Hospital from January to September 2024 were selected and divided into control group (n =33) and study group (n =33) by the random number table method. The control group was given fractional laser, and the study group was given micro-focused ultrasound technology combined with fractional laser. The Face-Q Scale (Face-Q), Derriford Cosmetic Appearance Scale (DCAS), Chinese version of the Facial Clinimetric Evaluation (FaCE) and satisfaction were compared between the two groups. Results After treatment, the scores of aesthetics, quality of life and postoperative adverse reactions in the study group were higher than those in the control group (P <0.05). After treatment, the scores of attraction, uniqueness, vitality and affinity in the study group were higher than those in the control group (P <0.05). After treatment, the scores of facial movement, sensation, oral function, eye sensation, tear secretion and social function in the study group were higher than those in the control group (P <0.05). The total satisfaction rate in the study group was 96.97%, which was higher than 75.76% in the control group (P <0.05). Conclusion In the treatment of facial skin anti-aging, micro-focused ultrasound technology combined with fractional laser can enhance the facial aesthetic effect, improve patients' facial condition, increase their confidence sense of appearance, and have higher patient satisfaction.