Objective To investigate the effect of radiofrequency combined with fractional laser in the treatment of facial skin photoaging. Methods A total of 108 patients with facial skin photoaging admitted to our hospital from June 2021 to June 2022 were selected as the research objects. They were divided into observation group and control group by random number table method, with 54 patients in each group. The control group was treated with radiofrequency, and the observation group was treated with radiofrequency combined with fractional laser. The clinical efficacy, symptom score, cosmetic effect and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.30%, which was higher than 83.33% in the control group (P<0.05). After treatment, the scores of pore size, skin texture, skin color and pigmentation in the observation group were lower than those in the control group (P<0.05). After treatment, the GAIS score in the observation group was higher than that in the control group, and the GPS score was lower than that in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Radiofrequency combined with fractional laser treatment can achieve better therapeutic effect in patients with facial skin photoaging, improve their skin condition and cosmetic effect, and has higher safety.