Objective To observe the effect of advanced optimal pulsed technology combined with fractional laser on facial scar in patients with scar. Methods A total of 87 scar patients admitted to Guizhou Provincial People's Hospital from January 2022 to June 2024 were selected as the research subjects. According to the random number table method, those patients were divided into the control group (n =43) and the observation group (n =44). The control group received fractional laser, while the observation group received advanced optimal pulsed technology combined with fractional laser. The clinical efficacy, facial scar scores, scar conditions and adverse reaction were compared between the two groups. Results Compared with the total effective rate of treatment in the control group (81.40%), the total effective rate of treatment in the observation group (95.45%) was higher (P <0.05). Compared with the control group, the scores of color, vascularity, pliability, thickness, pain and pruritus in the observation group after treatment were lower (P <0.05). Compared with the control group, the ECCA score in the observation group after treatment was lower (P <0.05). Compared with the incidence of adverse reaction in the control group (18.60%), the incidence of adverse reaction in the observation group (4.55%) was lower (P <0.05). Conclusion Advanced optimal pulsed technology combined with fractional laser is beneficial to improving patients' facial scar, enhancing clinical efficacy and reducing adverse reactions, which is worthy of clinical application.