Objective To compare the effects of remimazolam and midazolam in anesthesia for facial plastic surgery. Methods A total of 80 patients who underwent facial plastic surgery at Xi'an Yanta Johnson Star Children's Hospital from August 2022 to July 2024 were selected as the research subjects. According to the random number table method, they were divided into control group and research group, with 40 patients in each group. The control group was given midazolam for auxiliary anesthesia, and the research group was given remimazolam for auxiliary anesthesia. The awakening time, extubation time, spontaneous breathing recovery time, sedation effect and analgesic effect were compared between the two groups. Results The awakening time, extubation time and spontaneous breathing recovery time in the research group were shorter than those in the control group (P <0.05). The Riker sedation agitation score in the research group was lower than that in the control group (P <0.05). The VAS score in the research group at 1, 2 and 12 hours after surgery were lower than that in the control group (P <0.05). Conclusion The application effect of remimazolam in anesthesia for facial plastic surgery is better than that of midazolam. It can shorten the awakening time, extubation time and spontaneous breathing recovery time, effectively reduce the Sedation-Agitation Scale score, and is also beneficial to relieve the pain of patients, which is worthy of clinical application.