Objective To investigate the effect of orthodontic treatment based on facial soft tissue aesthetic analysis for adult malocclusion. Methods A total of 86 adult patients with malocclusion admitted to Department of Orthodontics, Jing’an District Dental Disease Prevention and Treatment Institute from January 2023 to September 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 43 patients in each group. The control group received conventional orthodontic diagnosis and treatment plan, and the observation group was treated with orthodontic treatment based on facial soft tissue aesthetic analysis on the basis of the control group. The facial soft tissue aesthetic indicators, occlusal relationship improvement, facial coordination and satisfaction were compared between the two groups. Results After treatment, the nasolabial angle, upper lip protrusion, lower lip protrusion and soft tissue facial convexity in the two groups were better than those before treatment, and those in the observation group were better than those in the control group (P<0.05). After treatment, the overbite, overjet, Little index and molar relationship score in the two groups were better than those before treatment, and those in the observation group were better than those in the control group (P<0.05). The comprehensive score of soft tissue aesthetics in the observation group was higher than that in the control group (P<0.05). The satisfaction of the observation group (90.70%) was higher than that of the control group (72.09%) (P<0.05). Conclusion Orthodontic treatment based on facial soft tissue aesthetic analysis can not only improve the occlusal relationship of adult patients with malocclusion, but also better optimize their facial aesthetic effect, and improve facial coordination and treatment satisfaction.