Functional and safety requirements for medical devices are increasing with the continuous advancement of medical technology. To improve the therapeutic effect and safety of medical devices and patients, researchers are constantly exploring new materials and processes. Among them, the preparation of functional surfaces has become an important means to improve the performance of medical devices. This paper provides a comprehensive and critical review of recent advancements in laser processing technologies for the fabrication of functional surfaces in medical devices. Leveraging the unique capabilities of laser-based techniques to precisely tailor micro- and nanoscale surface structures, these methods have demonstrated remarkable potential in enhancing the therapeutic efficacy, biocompatibility, and overall safety of medical implants and surgical instruments. Such innovations are paving the way for the development of next-generation medical devices with multifunctional surface properties, meeting the increasing demands of modern clinical applications. The review focuses on the key applications, including cell function regulation, antibacterial properties, corrosion resistance, friction characteristics, and anti-adhesion properties. It also explores the considerable potential of laser processing technology, while addressing the challenges associated with multifunctional surface design and material selection. Looking ahead, the paper discusses future directions for the application of laser processing in novel materials and complex biomimetic structures.