Objective To analyze the effect of intense pulsed light combined with Q-switched laser in the treatment of facial freckles. Methods A total of 80 patients with facial freckles diagnosed and treated in Guangzhou Dermatology Hospital from January 2020 to January 2024 were selected as the research subjects. They were divided into the control group and the study group by the Excel random function method, with 40 patients in each group. The control group was treated with Q-switched laser, and the study group was treated with intense pulsed light combined with Q-switched laser. The clinical efficacy, skin physiological characteristic indexes, adverse reactions and treatment satisfaction were compared between the two groups. Results The total effective rate of treatment in the study group was 97.50%, which was higher than 82.50% in the control group (P <0.05). After treatment, the scores of skin wrinkles, pigmented spots, texture, porphyrin precipitation and pores in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05). The incidence of adverse reactions in the study group was 5.00%, which was lower than 25.00% in the control group (P <0.05). The treatment satisfaction rate in the study group was 100.00%, which was higher than 87.50% in the control group (P <0.05). Conclusion The effect of intense pulsed light combined with Q-switched laser in the treatment of facial freckles is good, which can improve the skin physiological characteristics, enhance the treatment satisfaction of patients, and has high safety.