Objective To investigate the therapeutic effect of CO2 fractional laser combined with triamcinolone acetonide injection in patients with post-traumatic facial keloids. Methods A total of 120 patients with post-traumatic facial keloids treated at Xihu District Zhuantang Street Community Health Service Center from July 2022 to July 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 60 patients in each group. The control group received triamcinolone acetonide injection, and the study group received CO2 fractional laser combined with triamcinolone acetonide injection. The scar status, clinical efficacy and adverse reaction rate were compared between the two groups. Results After treatment, the scores of all dimensions of VSS and the total score in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P<0.05). The total effective rate in the study group (96.67%) was higher than that in the control group (85.00%) (P <0.05). The incidence of adverse reactions in the study group was lower than that in the control group, but the difference was not statistically significant (P >0.05). Conclusion The combined application of CO2 fractional laser and triamcinolone acetonide injection in patients with post-traumatic facial keloids can effectively improve keloid hyperplasia, restore the appearance of facial skin, while maintaining a low incidence of adverse reactions.