Objective: To explore the impact of scar risk-stratified personalized aesthetic nursing on postoperative wound recovery and patient satisfaction. Methods: A total of 100 patients undergoing elective surgery from January 2024 to December 2025 were enrolled and randomly divided into a control group and an observation group, with 50 cases each. The control group received routine wound care, while the observation group underwent tailored tension relief, silicone management, skin protection, and continuous follow-up based on scar risk stratification. Comparisons were made regarding the Redness, Edema, Erythema, Discoloration, and Approximation (REEDA) scale, Patient and Observer Scar Assessment Scale (POSAS), scar width, hypertrophic scar incidence, self-management compliance, and satisfaction. Results: The observation group exhibited lower REEDA scores, POSAS scores at all time points, scar width, and hypertrophic scar incidence compared to the control group, along with higher compliance and satisfaction (P < 0.05). Conclusion: Risk-stratified aesthetic nursing can improve wound recovery and scar appearance while enhancing sustained self-care compliance and satisfaction.