Objective To analyze the effect of precise stratified scar nursing on scar appearance and psychological status in patients with hypertrophic scars after burns. Methods The clinical data of 130 patients with hypertrophic scars after burns selected from the Second Affiliated Hospital of Kunming Medical University from July 2023 to June 2025 were retrospectively analyzed. According to different nursing methods, they were divided into the control group and the observation group, with 65 patients in each group. The control group received conventional nursing, and the observation group received precise stratified scar nursing. The scar appearance, psychological status, quality of life and scar pruritus and pain were compared between the two groups. Results After intervention, the scores of vascular distribution, pigmentation, height, pliability and total score in the observation group were lower than those in the control group (P <0.05). After 6 months of intervention, the scores of SAS and SDS in the two groups were lower than those before intervention, and those in the observation group were lower than those in the control group (P <0.05). After 6 months of intervention, the total scores of physical health and psychological health in the two groups were higher than those before intervention, and those in the observation group were higher than those in the control group (P <0.05). After 6 months of intervention, the VAS score of the two groups was lower than that before intervention, and that of the observation group was lower than that of the control group (P <0.05). Conclusion For patients with hypertrophic scars after burns, the application of precise stratified scar nursing can effectively improve scar appearance, relieve patients’ negative emotions, alleviate scar-related pruritusand pain, and enhance their quality of life.