Objective To explore the effect of target-oriented responsibility system nursing on scar recovery after cosmetic plastic debridement and suture in patients with maxillofacial trauma. Methods A total of 68 patients with maxillofacial trauma who underwent cosmetic plastic debridement and suture in Tianmen First People’s Hospital from September 2022 to October 2023 were selected as the research objects. They were divided into the reference group and the study group according to the random number table method, with 34 patients in each group. The reference group received routine nursing, and the study group received target-oriented responsibility system nursing. The stress response, scar recovery, quality of life, nursing satisfaction and psychological state were compared between the two groups. Results After intervention, the scores of scar melanin, vascularity, height and pliability in the study group were lower than those in the reference group (P <0.05). After intervention, the scores of various stress responses in the study group were lower than those in the reference group (P <0.05). After intervention, the scores of each dimension of quality of life in the study group were higher than those in the reference group (P <0.05). The nursing satisfaction in the study group was 94.12%, which was higher than 70.59% in the reference group (P <0.05). The SDS and SAS scores in the study group were lower than those in the reference group (P <0.05). Conclusion The application of target-oriented responsibility system nursing in patients with maxillofacial trauma can improve the scar recovery after cosmetic plastic debridement and suture, reduce the stress response and negative psychology, and is beneficial to improve the quality of life and nursing satisfaction of patients.