Objective To compare the efficacy and safety of Q-switched Nd:YAG laser and photon rejuvenation in the treatment of facial freckles. Methods A total of 88 patients with facial freckles admitted to Xi'an International Port Bohan Medical Beauty Clinic from March 2023 to March 2024 were selected as the research objects. According to different treatment schemes, they were divided into control group and study group, with 44 patients in each group. The control group was treated with photon rejuvenation, and the study group was treated with Q-switched Nd:YAG laser. The clinical efficacy, skin lesions, skin conditions, wound recovery time and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the study group was 97.73%, which was higher than 84.09% in the control group (P <0.05). After treatment, the skin lesion area, skin lesion color score and total score of the study group were lower than those of the control group (P <0.05). After treatment, the scores of pigmentation, purple, texture, pores and wrinkles in the study group were lower than those in the control group (P <0.05). There was no significant difference in wound recovery time between the two groups (P >0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The effect of Q-switched Nd:YAG laser in the treatment of facial freckles is better than that of photon rejuvenation. After treatment, the skin condition of patients is improved better, which is conducive to promoting the recovery of skin lesions. There is no significant difference in wound recovery time and incidence of adverse reactions between the two methods, and the safety is good.