Objective To analyze the effect of topical minoxidil tincture combined with carbon fractional lattice laser in the treatment of patients with alopecia. Methods A total of 88 patients with alopecia admitted to our hospital from July 2022 to June 2023 were randomly divided into control group and observation group, with 44 patients in each group. The control group was treated with topical minoxidil tincture, and the observation group was treated with carbon dioxide fractional laser on the basis of the control group. The clinical efficacy, onset time, hair diameter, hair density and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.45%, which was higher than 81.82% in the control group (P <0.05). The time of improvement, marked effect, recovery, vellus hair and terminal hair in the observation group was shorter than that in the control group (P <0.05). The hair diameter of the observation group was better than that of the control group at 4, 8, 12 and 16 weeks after treatment (P <0.05). The hair density of the observation group was better than that of the control group at 4, 8, 12 and 16 weeks after treatment (P <0.05). The incidence of adverse reactions in the observation group was 31.82%, which was higher than 15.91% in the control group, but the difference was not statistically significant (P >0.05). Conclusion The effect of topical minoxidil tincture combined with carbon dioxide fractional laser in the treatment of alopecia is definite, the effect of improving clinical symptoms is better, the onset time is shorter, and the incidence of adverse reactions will not be increased, which is worthy of clinical application.