Objective To explore the effect of fractional CO2 laser adjuvant therapy on alopecia area and hair follicle related parameters in patients with alopecia areata. Methods A total of 120 patients with alopecia areata admitted to Fengxian District Fengcheng Hospital from July 2022 to December 2024 were selected. According to the random number table method, they were divided into the control group and the experimental group, with 60 patients in each group. The control group was treated with minoxidil tincture, and the experimental group received fractional CO2 laser adjuvant therapy on the basis of the control group. The alopecia area improvement, hair follicle related parameters, quality of life, psychological state and adverse reaction rate were compared between the two groups. Results At 12 weeks after treatment, the SALT score of the two groups was lower than that before treatment, and that of the experimental group was lower than that of the control group (P <0.05). The hair follicle density and hair diameter of the two groups were higher than those before treatment, and those of the experimental group were higher than those of the control group (P <0.05). At 12 weeks after treatment, the DLQI score and SCL-90 total score of the two groups were lower than those before treatment, and those of the experimental group were lower than those of the control group (P <0.05). The incidence of adverse reactions in the experimental group was 8.33%, compared with 6.67% in the control group, the difference wasnot statistically significant (P >0.05). Conclusion Fractional CO2 laser adjuvant therapy for alopecia areata can effectively promote hair regrowth, improve hair follicle density and hair diameter, enhance patients' quality of life, ameliorate psychological state, and will not increase the risk of adverse reactions.