Objective To analyze the effect of carbon dioxide fractional laser technology on pain status in patients undergoing facial plastic and aesthetic surgery. Methods A total of 72 patients undergoing facial plastic and aesthetic surgery who visited Stomatology Hospital of Xi'an Jiaotong University from April 2022 to April 2025 were selected as the research subjects. According to the random number table method, they were divided into the conventional group and the treatment group, with 36 patients in each group. The conventional group was treated with botulinum toxin type A injection, and the treatment group was treated with carbon dioxide fractional laser technology. The pain status, Global Aesthetic Improvement Scale (GAIS) score, skin physiological indicators and adverse reaction rate were compared between the two groups. Results The VAS score of the treatment group after treatment was lower than that of the conventional group (P<0.05). The GAIS score of the treatment group after treatment was higher than that of the conventional group (P<0.05). After treatment, the skin elasticity and skin moisture percentage of the treatment group were higher than those of the conventional group, while the skin texture and skin wrinkle percentage were lower than those of the conventional group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Carbon dioxide fractional laser technology can effectively improve the skin condition of patients undergoing facial plastic and aesthetic surgery, reduce treatment pain, optimize skin physiological indicators, and does not cause serious adverse reactions.