Objective To observe the effect of asymmetric suture reconstruction on pain and scars in patients with earlobe keloid. Methods A total of 63 patients with earlobe keloid who visited our hospital from November 2022 to November 2024 and met the research criteria were selected as research subjects. According to the random number table method, they were divided into the control group (30 patients) and the observation group (33 patients). The control group received the conventional suture technique, and the observation group received the asymmetric suture reconstruction. The clinical efficacy, pain and scars were compared between the two groups. Results The total effective rate of treatment in the observation group was 93.94%, which was slightly higher than 83.33% in the control group, but the difference was not statistically significant (P >0.05). After treatment, the VAS score in the two groups was higher than that before treatment, and the difference was statistically significant (P <0.05). However, there was no significant difference in the VAS score between the two groups after treatment (P >0.05). After treatment, the scores of vascularity, color, thickness, surface roughness, softness and area in the two groups were lower than those before treatment, and the scores of vascularity, color, thickness, surface roughness, softness and area in the observation group after treatment were lower than those in the control group, and the differences were statistically significant (P <0.05). Conclusion The clinical effect of asymmetric suture reconstruction in earlobe keloid is definite, which can improve the scars of patients and cause less pain. It is worthy of application.