Objective To investigate the effect of modified Qingshang Fangfeng decoction on facial acne vulgaris and its impact on facial aesthetics. Methods Sixty patients with facial acne vulgaris admitted to Xinglong Community Health Service Center of Changzhou District from January 2020 to January 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 30 patients in each group. The control group was treated with clindamycin phosphate, and the observation group was treated with modified Qingshang Fangfeng decoction. The clinical efficacy, acne scar degree, facial aesthetics and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.67%, which was higher than 76.67% in the control group (P<0.05). The scores of acne scar nature and acne scar density in the observation group were lower than those in the control group (P<0.05). The facial beauty score of the observation group was higher than that of the control group (P<0.05). The incidence of adverse reactions in the observation group was 3.33%, which was lower than 26.67% in the control group (P<0.05). Conclusion The effect of modified Qingshang Fangfeng decoction in the treatment of facial acne vulgaris is ideal, which is beneficial to reduce the degree of acne scars, improve their facial aesthetics, and reduce the incidence of adverse reactions.