Introduction Ablative fractional CO2 lasers (AFCO2L) have been shown to improve hypertrophic burn scars (HBS). The purpose of this study was to review the 12-year patient cohort who received AFCO2L for HBS and identify independent factors associated with the application of AFCO2L Methods This retrospective HRE-approved study included all patients who received AFCO2L at the Western Australian Statewide Adult Burns Unit (SABU) from 2013 to 2024. Multivariate analyses were conducted to identify patient and burn factors associated with receiving AFCO2L. Patient subsets completed the Patient and Observer Scar Assessment Scale (POSAS 2.0), SF-36, and Itch Surveys. Their scar quality outcomes were compared over time using pre-post-laser analyses. Results The study involved 837 individuals who received 4005 laser sessions. Patients receiving AFCO2L tended to be female (454 patients,54.2%) with a median age of 31 (IQR: 21 to 45), without comorbidities (690,82.4%). Most lived in the metro region (621,74.2%), were completed as outpatients (66%), and were Fitzpatrick 2 (387,46.2%). Individuals who were more likely to receive AFCO2L were: younger (p<0.001), female (p<0.001), had a higher percentage TBSA burned (p<0.001), multiple anatomical areas affected (p=0.001), longer time to wound healing (p<0.001), and surgery (p<0.001). The subset analysis of POSAS scores after one laser showed significant reduction in itch scores (mean: 4.0 [1 x laser] v 5.3 [pre-laser]; p=0.018) and colour (mean: 7.1 [1 x laser] v 8.5 [pre]; p=0.02). Conclusions The study results demonstrated that AFCO2L is an efficacious treatment modality that can be targeted to specific burn patient profiles, improving scar quality and symptoms of HBS.