Objective To explore the clinical efficacy of early fractionated scar release combined with fractional laser therapy in patients with hypertrophic scars following facial and cervical burns. Methods A total of 76 patients with hypertrophic scars following facial and cervical burns admitted to Suining Central Hospital from November 2023 to November 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 38 patients in each group. The control group received fractional laser therapy, and the observation group received combined therapy of early fractionated scar release and fractional laser. The treatment effect, scar severity, pain and pruritus, adverse reaction rate and cosmetic satisfaction were compared between the two groups. Results The total effective rate of the observation group (97.37%) was higher than that of the control group (81.58%) (P <0.05). After treatment, the scores of VSS and VAS in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). The cosmetic satisfaction of the observation group (94.74%) was higher than that of the control group (78.95%) (P <0.05). Conclusion Early fractionated scar release combined with fractional laser achieves favorable efficacy in the treatment of hypertrophic scars following facial and cervical burns. It can effectively improve scar appearance, and relieve pain and pruritus, without increasing the incidence of adverse reactions after treatment, with high patient satisfaction. It is worthy of clinical application.