Objective: To study the therapeutic effect of autologous fat transplantation combined with carbon dioxide fractional laser on patients with hypertrophic scars after burns. Method One hundred patients with hypertrophic scars after burns admitted to our hospital from January 2023 to February 2025 were selected and grouped according to the random number table method. The control group (n=50) was treated with carbon dioxide fractional laser, while the observation group (n=50) was treated with autologous fat transplantation based on the control group. Compare the Vancouver Scar Scale (VSS) scores of the two groups before and after treatment; The Scar Assessment Scale (POSAS) scores of patients and observers before and after treatment; Laboratory indicators before and after treatment; Total effective rate of treatment; Incidence of adverse reactions. Result: After treatment, the VSS score of the observation group was lower than that of the control group (P < 0.05); After treatment, the POSAS score of the observation group was lower than that of the control group (P < 0.05). After treatment, all laboratory indicators of the observation group were better than those of the control group (P < 0.05). The total effective rate of treatment in the observation group was higher than that in the control group (P < 0.05). Comparison of the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: For patients with hypertrophic scars after burns, autologous fat transplantation combined with carbon dioxide fractional laser treatment can enhance the clinical efficacy, improve the degree of scars, and has good safety.