Objective To analyze the effect of ultrapulsed fractional CO2 laser combined with ffre needle therapy on erythema status and quality of life in patients with mild to moderate acne. Methods A total of 76 patients with mild to moderate acne admitted to Central Hospital of Qinghe County from February 2024 to February 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 38 patients in each group. The control group was treated with ultrapulsed fractional CO2 laser, and the observation group was treated with ultrapulsed fractional CO2 laser combined with ffre needle therapy. The clinical efffcacy, erythema status [Clinician Erythema Assessment (CEA)] and quality of life [Generic Quality of Life Inventory-74 (GQOLI-74)] were compared between the two groups. Results The total effective rate of the observation group (97.37%) was higher than that of the control group (78.95%) (P<0.05). The score of CEA in the two groups after treatment was lower than that before treatment, and that in the observation group was lower than that in the control group (P<0.05). The score of GQOLI-74 in the two groups after treatment was higher than that before treatment, and that in the observation group was higher than that in the control group (P<0.05). Conclusion The application of ultrapulsed fractional CO2 laser combined with ffre needle therapy in patients with mild to moderate acne has a good effect. It can effectively improve erythema and is conducive to enhancing patients' quality of life.