Objective To analyze the efficacy and safety of 585 nm pulsed dye laser combined with fractional CO2 laser and drug injection in the treatment of patients with hypertrophic scar. Methods A total of 84 patients with hypertrophic scar who received treatment in the Department of Plastic and Aesthetic Surgery, Xuzhou Central Hospital from May 2024 to May 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 42 patients in each group. The control group was treated with fractional CO2 laser and drug injection, and the observation group was treated with 585 nm pulsed dye laser combined with fractional CO2 laser and drug injection. The scar improvement, aesthetic satisfaction and adverse reaction rate were compared between the two groups. Results After treatment, the scores of scar thickness, softness, vascular distribution, color and total score in the observation group were lower than those in the control group (P<0.05). The aesthetic satisfaction of the observation group (97.62%) was higher than that of the control group (80.95%) (P<0.05). The incidenceof adverse reactions in the observation group (2.38%) was lower than that in the control group (16.67%) (P<0.05). Conclusion The combination of 585 nm pulsed dye laser, fractional CO2 laser and drug injection has a definite effect in the treatment of hypertrophic scar. It can effectively improve scar conditions, help to enhance aesthetic satisfaction, and has a low incidence of adverse reactions after treatment, with good efficacy and safety.