Objective To explore the effect of triamcinolone acetonide injection combined with ultra-pulsed CO2 fractional laser and AOPT intense pulsed light on scar improvement in patients with chest wall keloids. Methods A total of 90 patients with chest wall keloids admitted to our hospital from July 2022 to February 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 45 patients in each group. The control group received triamcinolone acetonide injection, and the observation group was treated with ultra-pulsed CO2 fractional laser and AOPT intense pulsed light on the basis of the control group. The clinical efffcacy, scar improvement and adverse reaction rate were compared between the two groups. Results The total effective rate of the observation group (95.56%) was higher than that of the control group (80.00%) (P<0.05). The scores of color, vascular distribution, thickness and softness of the observation group at 6 months after treatment were lower than those of the control group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Triamcinolone acetonide injection combined with ultra-pulsed CO2 fractional laser and AOPT intense pulsed light can effectively improve the treatment effect of chest wall keloids, optimize scar color, vascular distribution, thickness and softness, without increasing the risk of adverse reactions.