Objective To investigate the effect of Mohs micrographic surgery combined with adjacent flap aesthetic repair on appearance recovery in patients with superffcial basal cell carcinoma of the head and face. Methods A total of 60 patients with superffcial basal cell carcinoma of the head and face admitted to Nanchong Central Hospital from May 2024 to April 2025 were selected as the research subjects. According to different treatment plans, they were divided into the control group and the observation group, with 30 patients in each group. The control group received conventional extended resection, and the observation group received Mohs micrographic surgery combined with adjacent ffap aesthetic repair. The surgical indicators, appearance recovery and subjective appearance satisfaction were compared between the two groups. Results The total operation time in the observation group was longer than that in the control group, while the intraoperative blood loss and wound healing time were better than those in the control group (P<0.05). The scores of appearance recovery indicators in the observation group at 3 months after operation were all better than those in the control group (P<0.05). The satisfaction scores of natural appearance, impact on daily social interaction and self-acceptance in the observation group at 3 months after operation were better than those in the control group (P<0.05). Conclusion Mohs micrographic surgery combined with adjacent flap aesthetic repair in the treatment of superficial basal cell carcinoma of the head and face will prolong the total operation time, but it can effectively reduce intraoperative blood loss, shorten wound healing time, improve postoperativeappearance recovery, and enhance patients' subjective satisfaction with appearance.