Objective To investigate the clinical effect of remifentanil combined with dexmedetomidine in anesthesia of medical cosmetic surgery. Methods A total of 102 patients who underwent medical cosmetic surgery in China Railway Fuyang Hospital from November 2022 to November 2023 were selected. According to the different anesthetic drugs used, they were divided into group A and group B, with 51 patients in each group. Group A was anesthetized with propofol+fentanyl, and group B was anesthetized with remifentanil+dexmedetomidine. The anesthetic effect, anesthesia-related indicators, satisfaction and adverse reactions were compared between the two groups. Results The total effective rate of anesthesia in group B was 96.08%, which was higher than 76.47% in group A (P <0.05). The recovery time of anesthesia in group B was shorter than that in group A, and the Ramsay score after recovery and VAS score at 2 and 6 h after operation were lower than those in group A (P <0.05). The satisfaction rate of group B was 96.08%, which was higher than 80.39% of group A (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Remifentanil+dexmedetomidine has better anesthetic effect in medical cosmetology surgery, and it will not increase adverse reactions, with higher satisfaction.