To analyze the effect of refined cosmetic nursing on patients after burn plastic skin grafting. Methods A total of 100 patients after burn plastic skin grafting admitted to our hospital from August 2022 to July 2023 were randomly divided into control group and experimental group, with 50 patients in each group. The control group was treated with routine nursing, and the experimental group was treated with refined cosmetic nursing. The quality of life, pain, nursing effectiveness and incidence of adverse reactions were compared between the two groups. Results The scores of each dimension of quality of life in the experimental group were higher than those in the control group, and the differences were statistically significant (P <0.05). The VAS score and NRS score of the experimental group on the 1st, 3rd and 7th day after nursing were lower than those of the control group, and the differences were statistically significant (P <0.05). The total effective rate of nursing in the experimental group was 96.00%, which was higher than 72.00% in the control group, and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the experimental group was 14.00%, which was lower than 48.00% in the control group, the difference was statistically significant (P <0.05). Conclusion Refined cosmetic nursing has a good nursing effect in patients after burn plastic skin grafting, which can effectively improve their quality of life, reduce the degree of pain, and reduce the incidence of adverse reactions. It is a safe and effective nursing method.