To explore the application value of Z-plasty in the repair of facial linear scar. Methods A total of 50 patients with facial linear scar plastic repair admitted to the Eastern Hospital of Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 2020 to December 2021 were selected as the research objects. According to different treatment methods, they were divided into control group and observation group, with 25 patients in each group. The control group was treated with simple facial scar resection and suture, and the observation group was treated with Z-plasty. The scar recovery, adverse reactions and satisfaction were compared between the two groups. Results The color, flatness, elasticity and width of scar in the observation group were better than those in the control group, and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the observation group was 12.00%, which was lower than 36.00% in the control group, and the difference was statistically significant (P <0.05). The satisfaction rate of the observation group was 92.00%, which was higher than 64.00% of the control group, and the difference was statistically significant (P <0.05). Conclusion The effect of Z-plasty in patients with facial linear scar plastic repair is good, which can help patients recover the smoothness, color and elasticity of facial skin, with fewer adverse reactions and higher patient satisfaction.