Objective To explore the efficacy of ultrapulsed CO2 fractional laser combined with mechanical tension-reduction and silicone gel in the treatment of facial and cervical surgical incision scars under different treatment timing, and to identify the optimal intervention time. Methods The clinical data of 100 patients undergoing facial and cervical surgery admitted to Guangdong Second Provincial General Hospital Affiliated to Jinan University from February 2024 to January 2026 were retrospectively analyzed. According to the time of scar treatment after operation, they were divided into W1 group and M1 group, with 50 patients in each group. Both groups received multimodal intervention of ultrapulsed CO2 fractional laser combined with mechanical tensionreduction and silicone gel. The W1 group received intervention at 1 week after suture removal, while the M1 group received it at 1 month after suture removal. The scar width and thickness, VSS score, POSAS score, satisfaction and adverse reaction rate were compared between the two groups at 1 month after the last treatment. Results The scar width and thickness in W1 group were lower than those in M1 group (P <0.05). The VSS score of W1 group was lower than that of M1 group (P <0.05). The proportion of patients with POSAS score improvement ≥grade 1 in W1 group was 84.00%, which was higher than 42.00% in M1 group (P <0.05).The satisfaction in W1 group was higher than that in M1 group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Initiating multimodal intervention with ultrapulsed CO2 fractional laser combined with mechanical tension-reduction and silicone gel at 1 week after suture removal achieves better improvement in scar formation and morphology than intervention started at 1 month after suture removal. It can improve aesthetic appearance and patient satisfaction, and has good safety, without increasing the risk of adverse reactions.