Objective To explore the clinical effect of aesthetic concept-guided plastic repair surgery for penile morphological improvement and its influence on incision scar and erectile function. Methods A total of 70 patients with demands for penile morphological improvement admitted to the Department of Andrology of Shanxi Incaier General Hospital from January 2023 to January 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 35 patients in each group. The control group received conventional plastic repair surgery, and the observation group received aesthetic concept-guided plastic repair surgery. The external genital morphology, incision scar (VSS), functional recovery [erectile function (IIEF-5) and sensory recovery score] and complication rate were compared between the two groups. Results At 3 months after operation, all scores for external genital morphology in the observation group were higher than those in the control group, while all of scores VSS were lower than those in the control group (P <0.05). At 3 months after operation, the IIEF-5 score and sensory recovery score of the observation group were higher than those of the control group (P <0.05). The incidence of complications in the observation group was lower than that in the control group (P <0.05). Conclusion The application of aesthetic concept-guided plastic repair surgery can optimize scar quality while improving penile morphology, and effectively promote functional recovery, with high safety. It is worthy of clinical application.