Objective To explore the effect of positive nursing elements combined with cognitive behavioral intervention on body dysmorphic disorder in patients undergoing facial plastic surgery. Methods A total of 92 patients who underwent facial plastic surgery in the Department of Medical Cosmetology of our hospital from June 2024 to December 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 46 patients in each group. The control group received conventional nursing intervention in medical cosmetology treatment, and the observation group received positive nursing elements combined with cognitive behavioral intervention. The body dysmorphic disorder, social appearance anxiety, fear of negative evaluation and wound healing were compared between the two groups. Results The SRSBI score of the observation group after intervention was lower than that of the control group (P<0.05). The SAAS score of the observation group after intervention was lower than that of the control group (P<0.05). The FNE score of the observation group after intervention was lower than that of the control group (P<0.05). The excellent and good rate of wound healing in the observation group (100.00%) was higher than that in the control group (86.96%) (P<0.05). Conclusion The application of positive nursing elements combined with cognitive behavioral intervention in patients undergoing facial plastic surgery can effectively relieve body dysmorphic disorder, help to reduce psychological problems such as social appearance anxiety and fear of negative evaluation, and play a positive role in promoting wound healing.