Objective To explore the effect of facial liposuction combined with fat grafting on facial contour improvement in patients undergoing facial contour plastic surgery. Methods A total of 168 patients who underwent facial contour plastic surgery in Nanjing Miraway Medical Aesthetics Clinic from January 2023 to March 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the envelope method, with 84 patients in each group. The control group was treated with facial liposuction, and the observation group was combined with fat grafting on the basis of the control group. The facial contour improvement, self-acceptance and complication rate were compared between the two groups. Results The satisfaction rates of contour smoothness (88.10%) and contour tactile feel (92.86%) in the observation group were higher than those in the control group (73.81%, 76.19%) (P <0.05). The SAQ score in the observation group after treatment was higher than that in the control group (P <0.05). The incidence of complications in the observation group was lower than that in the control group (P <0.05). Conclusion Facial liposuction combined with fat grafting for patients undergoing facial contour plastic surgery can effectively improve facial contour ratio and soft tissue distribution, enhance self-acceptance, with a low incidence of complications.