Objective To analyze the effect of "Standard-Personalized" traditional Chinese medicine aesthetic nursing pathway on TCM syndrome scores in patients with melasma of liver depression and qi stagnation type. Methods A total of 182 patients with melasma of liver depression and qi stagnation type who received treatment in the Department of Traditional Chinese Medicine, Liuzhou People’s Hospital from January to December 2025 were selected for this retrospective study. A total of 90 patients who received conventional TCM aesthetic nursing from January to June 2025 were selected as the control group, and 92 patients who received "Standard-Personalized" TCM aesthetic nursing pathway intervention from July to December 2025 were selected as the observation group. The TCM syndrome scores, nursing efficacy, nursing satisfaction and complication rate were compared between the two groups. Results After nursing, the total TCM syndrome score and the scores of lesion area, color depth, emotional depression and irritability in the observation group were lower than those in the control group (P <0.05). The total effective rate of nursing in the observation group was 77.17%, which was higher than 55.56% of the control group (P <0.05). The nursing satisfaction scores in the observation group were higher than those in the control group (P <0.05). There was no significant difference in the incidence of complications between the two groups (P >0.05). Conclusion The "Standard-Personalized" TCM aesthetic nursing pathway can effectively improve skin lesions and emotional symptoms of patients with melasma of liver depression and qi stagnation type, improve nursing efficacy and patient satisfaction, and does not increase the risk of complications. It provides afeasible scheme for standardized and personalized practice of TCM aesthetic nursing.