Objective To analyze the effect of emergency cosmetic suture combined with type Abotulinum toxin in preventing scar hyperplasia in facial surgery. Methods A retrospective analysis of 56 patients with facial surgery admitted to the emergency department of our hospital from November 2022 to November 2023 was conducted. According to whether type Abotulinum toxin was used, the patients were divided into CG group and AX group, with 28 patients in each group. The CG group was treated with emergency cosmetic suture, and the AX group was treated with emergency cosmetic suture combined with type Abotulinum toxin. The clinical efficacy, scar condition, scar hyperplasia related factors and adverse reactions were compared between the two groups. Results After treatment, the total effective rate of AX group (96.43%) was higher than that of CG group (67.86%) (P <0.05). The scores of scar smoothness, scar color, scar elasticity and scar width in the AX group were lower than those in the CG group at 6 months after treatment (P <0.05). After treatment, the levels of growth transformation factor β1 (TGF-β1) and vascular endothelial growth factor in AX group were lower than those in CG group (P <0.05). The incidence of adverse reactions in the AX group (3.57%) was lower than that in the CG group (28.57%) (P <0.05). Conclusion For patients undergoing facial surgery, emergency cosmetic suture+type Abotulinum toxin can prevent postoperative scar hyperplasia, improve clinical efficacy, improve scar conditions, scar hyperplasia-related factor levels, and prevent adverse reactions.