Objective To analyze the effect of ultra-pulsed CO2 fractional laser combined with intense pulsed light on scar improvement in patients with post-cesarean hypertrophic scar. Methods A total of 58 patients with post-cesarean hypertrophic scar admitted to the Department of Medical Cosmetology, Nanjing Women and Children's Healthcare Hospital from March 2022 to July 2024 were selected. According to different treatment methods, they were divided into the control group (n =31) and the observation group (n =27). The control group was treated with ultra-pulsed CO2 fractional laser, and the observation group was treated with ultra-pulsed CO2 fractional laser combined with intense pulsed light. The clinical efficacy, scar improvement, scar pruritus, scar pain and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (92.59%) was higher than that in the control group (70.97%) (P <0.05). There were statistically significant differences in the color score and its △ value, vascular distribution △ value and total score △ value between the observation group and the control group after treatment (P <0.05), while there were no statistically significant differences in other indicators between the two groups (P >0.05). There were statistically significant differences in the pruritus △ value, pain △ value and total score △ value of pruritus and pain between the observation group and the control group (P <0.05). The incidence of blisters in the observation group was higher than that in the control group (P <0.05). There were no statistically significant differences in the incidence of pigmentation, infection and other adverse reactions between the two groups (P >0.05). Conclusion Ultra-pulsed CO2 fractional laser combined with intense pulsed light can effectively improve the vascular distribution, color, pruritus, and pain of post-cesarean hypertrophic scar, with good clinical effect. Except for occasional blisters, it does not increase the incidence of other adverse reactions.