Objective To explore the application effect of personalized local anesthesia technique in follicular unit extraction (FUE) autologous hair transplantation. Methods A total of 80 patients who underwent FUE autologous hair transplantation in Hangzhou Bisheng Medical Beauty Clinic Co., Ltd. from January 2024 to January 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 40 patients in each group. The control group was treated with conventional local anesthesia, and the study group was treated with personalized local anesthesia. The anesthesia effect, postoperative pain degree, complications and aesthetic satisfaction were compared between the two groups. Results The study group had higher the excellent and good rate of anesthesia effect (95.00%) than that in the control group (80.00%) (P <0.05). The VAS scores during operation, immediately after operation, and at 24 hours after operation in the study group were lower than those in the control group (P <0.05). The study group had lower the incidence of complications (5.00%) than that in the control group (25.00%) (P <0.05). The study group had higher aesthetic satisfaction rate (100.00%) than that in the control group (82.50%) (P <0.05). Conclusion The personalized local anesthesia technique has an ideal anesthesia effect in FUE autologous hair transplantation, which can effectively reduce patient pain and postoperative complications, and improve patient aesthetic satisfaction.