Objective To analyze the effect of holistic nursing in operating room on reducing local anesthesia stress response for patients with facial plastic surgery. Methods A total of 100 patients who underwent facial plastic surgery in our hospital from March 2022 to January 2024 were randomly divided into control g roup and observation group, with 50 patients in each group. The control group was given routine nursing, and the observation group was given holistic nursing in the operating room. The anesthesia stress response, psychological state, satisfaction, quality of life and facial recovery were compared between the two groups. Results The MAP and HR in the observation group were lower than those in the control group at 30 min during operation and 10 min after operation, the difference was statistically significant (P <0.05). After nursing, the SAS and SDS scores of the observation group were lower than those of the control group, the difference was statistically significant (P <0.05). The satisfaction scores of operating room environment, medical attitude, medical skills and emotional experience in the observation group were higher than those in the control group, the difference was statistically significant (P <0.05). The scores of all dimensions of quality of life in the observation group were higher than those in the control group, the difference was statistically significant (P <0.05). The scores of facial movement, facial sensation and oral function in the observation group were higher than those in the control group, the difference was statistically significant (P <0.05). Conclusion For patients with facial plastic surgery, holistic nursing program in operating room can effectively reduce the stress response of local anesthesia, improve the psychological state and quality of life of patients, which is conducive to improving patient satisfaction and promoting recovery.