Objective To explore the effect of rehabilitation nursing guided by the Transtheoretical Model of Behavior Change on hyperpigmentation area and negative emotions in patients undergoing scar plastic surgery after facial burn. Methods A total of 98 patients undergoing scar plastic surgery after facial burn admitted to our hospital from March 2023 to May 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 49 patients in each group. The control group was given conventional nursing, and the observation group was given rehabilitation nursing guided by the Transtheoretical Model of Behavior Change. The hyperpigmentation area and severity score, negative emotions, acceptance of disability, coping style, quality of life and nursing satisfaction were compared between the two groups. Results The scores of hyperpigmentation area and severity in the observation group were lower than those in the control group (P<0.05). After nursing, the scores of SAS and SDS in the observation group were lower than those in the control group (P<0.05). After nursing, the acceptance of disability and coping style in the observation group were better than those in the control group (P<0.05). After nursing, the scores of quality of life in the observation group were higher than those in the control group (P<0.05). The nursing satisfaction rate of the observation group (93.88%) was higher than that of the control group (75.51%) (P<0.05). Conclusion Theapplication of rehabilitation nursing guided by the Transtheoretical Model of Behavior Change in patients undergoing scar plastic surgery after facial burn can better improve hyperpigmentation and negative emotions, enhance the acceptance of disability, achieve positive coping, and improve nursing satisfaction and quality of life.