Objective To compare the anesthetic effects of different doses of dexmedetomidine combined with propofol and remifentanil in aesthetic and plastic surgery. Methods A total of 72 patients who underwent aesthetic and plastic surgery in Rugao Bo'ai Hospital and Naval Medical Center from November 2022 to March 2025 were selected. According to the random number table method, they were divided into group A and group B, with 36 patients in each group. All patients were anesthetized with dexmedetomidine combined with propofol and remifentanil. Group A received intravenous infusion of low-dose dexmedetomidine (0.2 μg/kg) within 10 minutes of anesthesia induction, and group B received high-dose dexmedetomidine (0.5 μg/kg) within the same time. The dosage of anesthetic drugs, perioperative indicators and adverse event rate were compared between the two groups. Results There were no statistically significant differences in the dosages of propofol and remifentanil between the two groups (P>0.05). The dosage of dexmedetomidine in group A was lower than that in group B (P<0.05). The postoperative extubation time, awakening time, and hospitalization time in group A were shorter than those in group B (P<0.05). There were no statisticallysignificant differences in intraoperative blood loss and operation time between the two groups (P>0.05). The incidence of adverse events in group A (5.56%) was lower than that in group B (27.78%) (P<0.05). Conclusion The combination of low-dose dexmedetomidine with propofol and remifentanil can effectively shorten the postoperative awakening time, extubation time and hospitalization time of patients undergoing aesthetic and plastic surgery on the premise of reducing the dosage of dexmedetomidine, and simultaneously reduce the incidence of postoperative adverse events. The anesthetic effect is better than that of high-dose dexmedetomidine.