Objective To explore the effect of ultra-pulsed fractional CO2 laser combined with intense pulsed light on skin severity and skin aesthetics in patients with hypertrophic scar. Methods A total of 80 patients with hypertrophic scar who received treatment in the Department of Dermatology, the Second People's Hospital of Shenzhen from January 2023 to December 2024 were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group was treated with ultra-pulsed fractional CO2 laser, and the observation group was treated with ultra-pulsed fractional CO2 laser combined with intense pulsed light. The skin severity, skin aesthetics, clinical efficacy and patient satisfaction were compared between the two groups. Results The scores of each item of mVSS and skin aesthetics in the observation group after treatment were lower than those in the control group (P <0.05). The total effective rate of treatment in the observation group (95.00%) was higher than that in the control group (80.00%) (P <0.05). The satisfaction rate in the observation group (92.50%) was higher than that in the control group (72.50%) (P <0.05). Conclusion The treatment of intense pulsed light combined with ultra-pulsed fractional CO2 laser for patients with hypertrophic scar can alleviate skin severity, enhance aesthetics and clinical efficacy, and is widely recognized by patients.