Objective To investigate the effect of comprehensive postoperative incision aesthetic nursing on incision aesthetics and scar in patients undergoing gynecological surgery. Methods From June 2022 to March 2023, 88 patients undergoing gynecological laparotomy in our hospital were randomly divided into control group and study group, with 44 patients in each group. The control group was given routine postoperative incision nursing, while the study group was given comprehensive postoperative incision aesthetic nursing. The incision healing, width and thickness of scar, VSS、PSAS、OSAS aesthetic satisfaction score of surgical incision and aesthetic degree of postoperative incision healing were compared between the two groups. Results The healing rate of grade A in the study group was higher than that in the control group, and the healing rate of grade B and grade C was lower than that in the control group (P <0.05). The thickness and width of scar in the study group were smaller than those in the control group (P <0.05). The VSS score of the study group was lower than that of the control group at 3 and 6 months after operation (P <0.05). The PSAS score of the study group was lower than that of the control group at 6 months after operation (P <0.05). The OSAS score of the study group was lower than that of the control group at 3 and 6 months after operation (P <0.05). The incision aesthetic satisfaction score of the study group was higher than that of the control group at 3 and 6 months after operation (P <0.05). Conclusion Comprehensive postoperative incision aesthetic nursing for patients undergoing gynecological surgery is conducive to reducing the width and thickness of incision scar, promoting incision healing, improving the long-term aesthetics of incision, and is conducive to scar desalination, which can have a positive impact on postoperative psychological and physical recovery of patients.