Objective To compare the effects of simultaneous and staged extraction of bilateral mandibular impacted wisdom teeth on facial aesthetic indicators and complications. Methods A total of 80 patients who underwent bilateral mandibular impacted wisdom tooth extraction in the Implant Room of Kailu Yuchi Dental Clinic Co., Ltd. from January 2024 to December 2025 were selected. According to the random number table method, they were divided into the simultaneous extraction group and the staged extraction group, with 40 patients in each group. The simultaneous extraction group received sequential extraction of bilateral mandibular impacted wisdom teeth during the same anesthesia session. The staged extraction group had one mandibular impacted wisdom tooth extracted at a time, with a surgery interval of 4 to 8 weeks between the two sides. The pain intensity, facial aesthetic indicators, complications, facial symmetry, soft tissue recovery index of mandibular angle and facial satisfaction were compared between the two groups. Results The VAS scores in the staged extraction group at 24 and 72 hours after operation and 7 days after operation were lower than those in the simultaneous extraction group (P <0.05). The increased swelling value and reduced mouthopening value in the staged extraction group at 72 hours after operation were lower than those in the simultaneous extraction group (P <0.05). There was no statistically significant difference in the incidence of complications between the two groups (P >0.05). The facial symmetry score in the staged extraction group at 7 days after operation was higher than that in the simultaneous extractiongroup (P <0.05). There was no statistically significant difference in facial symmetry score between the two groups at 30 days after operation (P >0.05). The soft tissue recovery index of mandibular angle in the staged extraction group at 30 days after operation was (1.89±0.35) mm, which was lower than (2.31±0.93) mm in the simultaneous extraction group (P <0.05). The facial satisfaction score in the staged extraction group at 7 days after operation was higher than that in the simultaneous extraction group (P <0.05). There was no statistically significant difference in facial satisfaction score between the two groups at 30 days after operation (P >0.05). Conclusion Staged extraction of bilateral mandibular impacted wisdom teeth can relieve early postoperative pain, swelling and mouth opening limitation, achieve better short-term facial aesthetic effect, without increasing the risk of complications, which is worthy of clinical application.