Objective To explore the effect of individualized aesthetic nursing based on scar risk stratiffcation on incision healing after surgery. Methods A total of 100 patients undergoing elective surgery in the No.2 People’s Hospital of Lanzhou from January 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 50 patients in each group. The control group was given conventional incision nursing, and the observation group was given individualized aesthetic nursing based on scar risk stratiffcation on the basis of the control group. The incision healing status, scar quality, self-management compliance, satisfaction and adverse reaction rate were compared between the two groups. Results The REEDA score of the observation group at 7 days after operation was lower than that of the control group (P<0.05). The POSAS scores of the observation group at 1, 3 and 6 months after operation were lower than those of the control group (P<0.05). The scar width and incidence of hypertrophic scar in the observation group at 6 months after operation were lower than those in the control group (P<0.05). The self-management compliance score and satisfaction score of the observation group were higher than those of the control group (P<0.05). The incidence of adverse reactions in the observation group was 10.00%, which was lower than 12.00% of the control group, but the difference was not statistically significant (P>0.05). Conclusion Individualized aesthetic nursing based on scar risk stratification can improve incision healing and scar appearance, enhance patients’ self-management compliance and satisfaction, and will not increase the risk of adverse reactions, which is worthy of clinical application.