Objective To explore the effect of fractional laser-assisted transdermal drug delivery on skin scars in patients with skin cosmetology and disfiguring dermatosis. Methods From January 2022 to December 2023, 110 patients with skin cosmetology and disfiguring dermatosis admitted to the Department of Dermatology, Guiping People’s Hospital were retrospectively selected as the research subjects. According to different treatment methods, they were divided into the control group and the observation group, with 55 patients in each group. The control group was given conventional drugs, and the observation group was given fractional laser-assisted transdermal drug delivery. The clinical efficacy, skin scars, quality of life and adverse reactions were compared between the two groups. Results The total clinical effective rate in the observation group (94.55%) was higher than that in the control group (80.00%) (P <0.05). After treatment, the score of VSS in the two groups was lower than that before treatment, and that in the observation group was lower than that in the control group (P <0.05). After treatment, the scores of work and study, daily life, personal relationships, leisure and entertainment, symptoms and treatment in the observation group were all better than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The fractional laser-assisted transdermal drug delivery has excellent clinical efficacy in the treatment of skin cosmetology and disfiguring dermatosis. It can promote scar repair, relieve the pain of patients, thereby improving their quality of life, without increasing adverse reactions.