Objective To investigate the clinical efficacy of triamcinolone acetonide injection combined with ultrapulse CO2 fractional laser and advanced optimal pulse technology intense pulsed light (AOPT-IPL) in the treatment of chest wall keloids. Methods 90 patients diagnosed with chest wall keloids at our hospital between July 2022 and February 2025 were enrolled in this study. Using a randomized number table, participants were allocated equally into an observation group and a control group, each comprising 45 individuals. Patients in the control group underwent conventional therapy consisting solely of triamcinolone acetonide injections. In contrast, the observation group received a combined regimen that integrated conventional injection therapy with ultrapulse CO2 fractional laser, and AOPT-IPL. Evaluations were conducted six months after treatment completion, comparing the two groups in terms of clinical efficacy, scar scores assessed by the Vancouver Scar Scale (VSS), and the incidence of adverse reactions. Results The observation group demonstrated a significantly higher total effective rate compared to the control group (P<0.05). At six months post-treatment, the VSS scores of the observation group in terms of pigmentation, vascularity, thickness, and pliability were all significantly lower than those of the control group (P<0.05). The incidence of adverse reactions did not differ significantly between the two treatment groups (P>0.05). Conclusion The combination of triamcinolone acetonide injection, ultrapulse CO2 fractional laser, and AOPT-IPL significantly improves clinical efficacy in treating chest wall keloids, effectively enhancing scar pigmentation, vascularity, thickness, and pliability. This represents a safe and effective comprehensive treatment strategy.