Objective To explore the effect of intense pulsed light combined with Q-switched laser on freckle severity in patients with facial freckles. Methods A total of 60 patients with facial freckles who received treatment in the Department of Dermatology, Nanjing Jiangning Suwang Cosmetic Hospital from September 2023 to September 2024 were selected. According to the random number table method, they were divided into the control group and the observation group, with 30 patients in each group. The control group was treated with Q-switched laser, and the observation group was treated with intense pulsed light combined with Q-switched laser. The freckle severity, facial aesthetics, skin barrier function, clinical efffcacy and adverse reaction rate were compared between the two groups. Results After treatment, the PSI score of the observation group was lower than that of the control group (P<0.05). After treatment, the facial aesthetics score of the observation group was higher than that of the control group (P<0.05). After treatment, the sebum content and skin water content of the observation group were higher than those of the control group, while the transepidermal water loss was lower than that of the control group (P<0.05). The total effective rate of the observation group (96.67%) was higher than that of the control group (80.00%) (P<0.05). The incidence of adverse reactions in the observation group (3.33%) was lower than that in the control group (20.00%) (P<0.05). Conclusion Intense pulsed light combined with Q-switched laser can not only eliminate facial freckles, but also help to repair and enhance skin barrier function, reduce the severity of freckles, decrease the incidence of adverse reactions, and effectively improve patients' facial aesthetics and overall satisfaction.