Objective To analyze the effect of rehabilitation nursing under the guidance of behavioral change theory on improving the psychological state and compliance of patients with scar plastic surgery after facial burns. Methods A total of 60 patients with facial burn who underwent scar plastic surgery in our hospital from June 2023 to June 2024 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 30 patients in each group. The control group was given routine rehabilitation nursing, while the observation group was given rehabilitation nursing under the guidance of behavioral change theory. The disability acceptance, scar improvement, psychological state, compliance and complications were compared between the two groups. Results The ADS-R score of the observation group after nursing was higher than that of the control group (P <0.05). The VSS score of the observation group after nursing was lower than that of the control group (P <0.05). The SAS and SDS score of the observation group after nursing were lower than those of the control group (P <0.05). The compliance of the observation group was 86.67%, which was higher than 70.00% of the control group (P <0.05). The incidence of complications in the observation group was 3.33%, which was lower than 13.33% in the control group (P <0.05). Conclusion Rehabilitation nursing under the guidance of behavioral change theory in the nursing of patients with scar plastic surgery after facial burns can improve the disability acceptance and psychological state of patients, improve their compliance, promote scar improvement, and effectively reduce the incidence of complications. The application value is accurate.