Background: Hypertrophic scarring presents a significant therapeutic challenge in dermatologic practice. Fractional CO₂ laser therapy has emerged as a promising treatment modality, yet comprehensive clinical data remains limited. Objective: To evaluate the efficacy and safety of fractional CO₂ laser therapy in the management of hypertrophic scars through objective and subjective parameters. Methods: Forty-five patients with hypertrophic scars underwent three sessions of fractional CO₂ laser treatment at 6-week intervals. Outcomes were assessed using Vancouver Scar Scale (VSS), digital caliper measurements, standardized photographs, patient-reported outcomes, and independent observer evaluation. Results: Mean scar thickness decreased from 3.8 ± 0.9 mm to 2.0 ± 0.5 mm (47.4% reduction, p<0.001), as measured by digital caliper with high inter-observer reliability (ICC: 0.91-0.94). Total VSS scores improved from 9.8 ± 2.1 to 4.5 ± 1.1 (p<0.001). Patient-reported pain and pruritus showed significant reduction (mean change: -4.4 points, p<0.001). Independent observer assessment demonstrated 51-75% improvement in 46.7% of cases (Kappa=0.84). Younger scars (≤1 year) showed superior response compared to older scars (VSS improvement: 5.8 ± 1.2 vs 4.9 ± 1.1, p=0.023). Transient adverse events included erythema (100%) and edema (93.3%), with mean recovery time of 5.8 ± 1.4 days. Conclusion: Fractional CO₂ laser therapy provides significant improvement in hypertrophic scars with a favorable safety profile and minimal downtime. Early intervention yields superior outcomes, suggesting optimal timing as an important consideration in treatment planning.