To analyze the effect of V-shaped foreskin plastic surgery in the treatment of adult phimosis patients. Methods A total of 90 adult phimosis patients admitted to our hospital from November 2022 to November 2023 were randomly divided into reference group and study group, with 45 patients in each group. The reference group was treated with traditional circumcision, and the study group was treated with V-shaped circumcision. The clinical efficacy, aesthetic satisfaction, surgical indicators and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the study group was 95.56%, which was higher than 86.67% in the reference group (P <0.05). The aesthetic satisfaction of the study group was 93.33%, which was higher than 84.44% of the reference group (P <0.05). The operation time, postoperative continuous pain time, incision healing time and intraoperative blood loss in the study group were better than those in the reference group (P <0.05). The incidence of adverse reactions in the study group was 15.56%, which was lower than 64.44% in the reference group (P <0.05). Conclusion The application effect of V-shaped foreskin plastic surgery in adult phimosis patients is good, which can effectively improve the total effective rate of treatment, optimize the surgical indicators, and the incidence of postoperative adverse reactions is small, and the postoperative aesthetic satisfaction is high.