Objective To explore the clinical effect of CO2 fractional laser in the treatment of facial skin photoaging. Methods A total of 70 patients with facial skin photoaging admitted to our hospital from January 2021 to October 2022 were randomly divided into control group and observation group, with 35 patients in each group. The control group was treated with intensive pulsed light, and the observation group was treated with CO2 fractional laser. The clinical efficacy, symptom scores before and after treatment, treatment satisfaction and complications were compared between the two groups. Results The effective rate of treatment in the observation group was 97.14%, which was higher than 82.86% in the control group, but the difference was not statistically significant (P>0.05). After treatment, the pore size, skin texture, skin color and pigmentation scores of the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P<0.05). The satisfaction of the observation group was higher than that of the control group (P<0.05). The incidence of complications in the observation group was lower than that in the control group (P<0.05). Conclusion CO2 fractional laser has a better effect in the treatment of facial skin photoaging patients, which can improve the clinical symptoms of patients, with lower incidence of complications and hiher patients' satisfaction, and is worthy of clinical application.