Objective: To explore the application effect of rehabilitation nursing guided by the Transtheoretical Model of Behavior Change in patients undergoing scar plastic surgery after facial burns. Methods: A total of 98 patients who underwent scar plastic surgery after facial burns admitted to our hospital from March 2023 to May 2025 were selected and divided into two groups with 49 cases each according to the random number table method. The control group received routine nursing, and the observation group received rehabilitation nursing guided by the Transtheoretical Model of Behavior Change. The area and severity score of pigmentation, negative emotions, acceptance of disability, coping style, nursing satisfaction and quality of life were compared between the two groups. Results: The area and severity score of pigmentation in the observation group were better than those in the control group (P<0.05). There was no significant difference in negative emotions between the two groups before nursing (P>0.05). After nursing, the improvement of the observation group was better than that of the control group (P<0.05). There was no significant difference in acceptance of disability and coping style between the two groups before nursing (P>0.05). After nursing, the improvement of the observation group was better than that of the control group (P<0.05). The nursing satisfaction of the observation group was 93.88%, which was higher than 75.51% of the control group (P<0.05). There was no significant difference in quality of life between the two groups before nursing (P>0.05). After nursing, the improvement of the observation group was better than that of the control group (P<0.05). Conclusion: The implementation of rehabilitation nursing guided by the Transtheoretical Model of Behavior Change in patients undergoing scar plastic surgery after facial burns can better improve pigmentation and negative emotions, reduce the degree of disability, achieve positive coping, and improve nursing satisfaction and quality of life.