Objective To explore the effect of cosmetic suture on facial aesthetics in patients undergoing maxillofacial trauma plastic surgery. Methods A total of 78 patients undergoing maxillofacial trauma plastic surgery admitted to the Department of Trauma, Beijing Daxing District People's Hospital from February 2023 to February 2025 were selected as the research subjects, according to different surgical treatment plans, they were divided into the reference group and the experimental group, with 39 patients in each group. The reference group was treated with conventional debridement and suture, and the experimental group was treated with cosmetic suture. The postoperative recovery indicators, facial aesthetics, inflammatory and repair indicators, adverse reaction rate and pain degree were compared between the two groups. Results The duration of postoperative edema and wound healing time in the experimental group were shorter than those in the reference group (P <0.05). The scores of facial symmetry, skin color and overall facial aesthetics in the experimental group after surgery were higher than those in the reference group (P <0.05). The levels of IL-6 and CRP in the experimental group after surgery were lower than those in the reference group, and the level of hEGF was higher than that in the reference group (P <0.05). The incidence of adverse reactions in the experimental group was 2.56%, which was lower than 17.95% in the reference group (P <0.05). The pain scores of the experimental group at 1 and 3 days after surgery were lower than those in the reference group (P <0.05). Conclusion In maxillofacial trauma plastic surgery, the application of cosmetic suture can optimize postoperative recovery indicators, effectively improve facial aesthetics, and show comprehensive advantages in reducing patients' pain, controlling inflammatory reactions, and lowering the incidence of adverse reactions.