Objective To explore the efficacy and safety of fractional laser combined with platelet-rich plasma (PRP) in the treatment of facial acne scar. Methods A total of 82 patients with facial acne scar admitted to our hospital from October 2023 to May 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 41 patients in each group. The control group was treated with fractional laser, and the observation group was treated with fractional laser combined with PRP. The scar scores, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the scores of thickness, vascular distribution, color, and softness in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P <0.05). The total effective rate of treatment in the observation group was 97.56%, which was higher than 80.49% in the control group (P <0.05). The incidence of adverse reactions in the observation group (4.88%) was lower than that in the control group (21.95%) (P <0.05). Conclusion The combined application of fractional laser and PRP in the treatment of facial acne scar can relieve the symptoms of acne scar, improve the clinical efficacy, and reduce the risk of adverse reactions.