To explore the effects of abdominal wall fat treatment and wound suture repair methods on incision healing in obese patients undergoing cesarean section. Methods A total of 110 obese patients undergoing cesarean section in Shijiazhuang Luquan People's Hospital from June 2018 to June 2023 were selected as the research objects. According to different suture methods, they were divided into control group and study group, with 55 patients in each group. In the control group, the whole layer of fat was sutured intermittently and the wound suture was repaired by intradermal indirect suture when the abdominal wall fat was treated. In the study group, the fat layer was not sutured and the wound suture was repaired by direct intradermal continuous suture when the abdominal wall fat was treated. The incision healing, operation time, hospitalization time, complication rate, comfort, postoperative pain score and satisfaction were compared between the two groups. Results The proportion of grade A healing of incision in the study group was higher than that in the control group, and the operation time and hospitalization time were shorter than those in the control group, the differences were statistically significant (P <0.05). The incidence of fat liquefaction, incision redness and swelling, incision malalignment and knot reaction in the study group was lower than that in the control group, and the difference was statistically significant (P <0.05). 3 days after operation, the BCS score of the study group was higher than that of the control group and the VAS score was lower than that of the control group, the differences were statistically significant (P <0.05). The satisfaction in the study group was 94.55%, which was higher than 78.18% in the control group, and the difference was statistically significant (P <0.05). Conclusion Abdominal wall fat treatment without suturing the fat layer, and direct intradermal continuous suture in wound suture repair is helpful to promote wound healing, relieve postoperative pain, reduce the risk of complications, and improve patient comfort and satisfaction.