Objective To analyze the application e?ect of lidocaine local anesthesia in aesthetic plastic surgery. Methods A total of 80 patients who underwent aesthetic plastic surgery in our hospital from January 2021 to August 2022 were randomly divided into control group and experimental group, with 40 patients in each group. The control group was treated with ropivacaine for local anesthesia before operation, and the experimental group was treated with lidocaine for local anesthesia before operation. The mean pulse pressure (MAP) and heart rate (HR) from T0 to T4, pain degree, incidence of adverse events and satisfaction were compared between the two groups. Results The MAP, HR and VAS scores of the experimental group at T1-T4 were better than those of the control group (P<0.05). The incidence of adverse events in the experimental group was 2.50%, which was lower than 17.50% in the control group (P<0.05). The satisfaction rate of the experimental group was 97.50%, which was higher than 80.00% of the control group (P<0.05). Conclusion The application e?ect of lidocaine local anesthesia in aesthetic plastic surgery is ideal, which can play a good analgesic and sedative role, stabilize the blood pressure and heart rate of patients during the operation. Meanwhile, it can reduce the incidence of adverse events during the operation, improve the patient satisfaction and doctor-patient relationship.