Objective To explore the effect of silicone gel combined with ultra-pulsed CO2 fractional laser in the treatment of early scar after facial cosmetic suture. Methods A total of 100 patients with early scar after facial cosmetic suture admitted to Xingyi People's Hospital from March 2023 to March 2025 were divided into the control group and the study group by the random number table method, with 50 patients in each group. The control group was treated with silicone gel, and the study group was treated with silicone gel combined with ultra-pulsed CO2 fractional laser. The clinical efficacy, scar score, skin recovery time (pain duration, erythema duration, descrustation time) and adverse reaction rate were compared between the two groups. Results The total effective rate of treatment in the study group was 98.00%, which was higher than 82.00% in the control group (P <0.05). The scar score of the study group after treatment was lower than that of the control group (P <0.05). The pain duration, erythema duration and descrustation time of the study group were shorter than those of the control group (P <0.05). The incidence of adverse reactions in the study group after treatment was lower than that in the control group (P <0.05). Conclusion For patients with early scar after facial cosmetic suture, silicone gel combined with ultra-pulsed CO2 fractional laser has a good effect. It can effectively improve scar conditions, accelerate skin recovery time, and reduce the incidence of adverse reactions.