Objective To explore the effect of intense pulsed light combined with Q-switched laser on the severity of freckles in patients with facial freckles. Methods From September 2023 to September 2024, 60 patients with facial freckles who were treated in the dermatology department of Suwang Beauty Hospital in Jiangning, Nanjing were randomly divided into control group and observation group, with 30 patients in each group. The control group was treated with Q-switched laser, while the observation group was treated with intense pulsed light combined with Q-switched laser. The severity of freckles, facial beauty, skin barrier function, clinical efficacy and incidence of adverse reactions were compared between the two groups. Results The PSI score of the observation group was lower than that of the control group after treatment (P < 0.05). After treatment, the facial beauty score of the observation group was higher than that of the control group (P < 0.05). After treatment, the sebum content and skin water content in the observation group were higher than those in the control group, and the skin water loss was lower than that in the control group (P < 0.05). The total effective rate in the observation group (96.67%) was higher than that in the control group (80.00%) (P < 0.05). The incidence of adverse reactions in the observation group (3.33%) was lower than that in the control group (20.00%) (P < 0.05). Conclusion Intense pulsed light combined with Q-switched laser can improve skin barrier function in patients with facial freckles, reduce the severity of freckles, but also reduce the incidence of adverse reactions, and effectively improve the facial aesthetics and overall satisfaction of patients.