Objective: To investigate the aesthetic improvement and safety of subcision combined with carbon dioxide (CO?) fractional laser in the treatment of facial atrophic scars. Methods: A total of 51 patients with facial atrophic scars treated in our hospital from March 2021 to January 2025 were randomly assigned to the study group (subcision + CO? fractional laser) and the control group (CO? fractional laser alone). Scar scores, skin texture improvement, patient satisfaction, and adverse reactions were compared between the two groups before and at multiple time points after treatment. Results: After treatment, the study group showed significantly lower scar scores and higher patient satisfaction than the control group (P < 0.05). Improvements in scar depression depth and skin smoothness were also significantly greater in the study group (P < 0.05). The incidence of adverse reactions was similar between the two groups, with no significant difference (P > 0.05). Conclusion: Subcision combined with CO? fractional laser provides more effective improvement in facial atrophic scars compared with CO? fractional laser alone, enhances aesthetic satisfaction, and demonstrates good safety, making it a valuable clinical approach.