Objective To analyze the clinical effect of hyaluronic acid dressing combined with ultra-pulsed CO2 fractional laser in patients with facial depressed acne scars and its influence on negative emotions. Methods A total of 80 patients with facial depressed acne scars admitted to the Department of Burns and Plastic Surgery, Jingmen Traditional Chinese Medicine Hospital from June 2023 to February 2026 were selected, and they were divided into the control group (n =40, treated with ultra-pulsed CO2 fractional laser) and the observation group (n =40, treated with hyaluronic acid dressing combined with ultra-pulsed CO2 fractional laser) by the random number table method. The clinical effect, wound repair indicators, negative emotions and adverse reaction rate were compared between the two groups. Results Compared with the total effective rate of treatment in the control group (67.50%) , the observation group (92.50%) was higher (P <0.05). Compared with the control group, the duration of scab and scab skin shedding in the observation group was shorter, the incidence of adverse reactions and the scores of pain (NRS), anxiety (HAMA) and depression (HAMD) in the observation group were lower (P <0.05). Conclusion Hyaluronic acid dressing combined with ultrapulsed CO2 fractional laser for facial depressed acne scars can shorten the wound repair cycle, reduce the incidence of adverse reactions, and alleviate the negative emotions of anxiety and depression.