Objective To explore the effect of whole-course reffned nursing based on aesthetic needs on scar recovery in patients with extensive burn. Methods A total of 84 patients with extensive burn admitted to the Institute of Burn, Frostbite and Tissue Function Reconstruction, Armed Police Characteristic Medical Center from January 2023 to September 2025 were selected as the research subjects. According to different nursing methods, they were divided into the control group and the observation group, with 42 patients in each group. The control group received conventional nursing, and the observation group received whole-course reffned nursing based on aesthetic needs on the basis of the control group. The scar recovery, psychological mood, aesthetics and pain intensity were compared between the two groups. Results After nursing, the scores of color, thickness, vascular distribution and softness in the observation group were lower than those in the control group (P<0.05). The scores of anxiety and depression in the observation group after nursing were lower than those in the control group (P<0.05). The aesthetic score of the observation group after nursing was higher than that of the control group (P<0.05). The score of pain intensity in the observation group after nursing was lower than that in the control group (P<0.05). Conclusion Whole-course reffned nursing based on aesthetic needs for patients with extensive burn can improve scar recovery, enhance aesthetic appearance, relieve pain symptoms, and improve mental health.