Objective To explore the effect of facial soft tissue 3D reconstruction on facial aesthetic effect in patients undergoing orthodontics treatment. Methods A total of 76 orthodontics patients admitted to The Third Medical Center of Chinese PLA General Hospital from September 2018 to June 2024 were selected, and they were divided into the control group and the observation group according to different treatment plans, with 38 patients in each group. The control group adopted facial 2D reconstruction, and the observation group adopted facial soft tissue 3D reconstruction. The treatment status, aesthetic effect, recovery status and satisfaction were compared between the two groups. Results The treatment time and number of follow-up visits in the observation group were better than those in the control group (P<0.05). The aesthetic effect score of the two groups after treatment was higher than that before treatment, and that of the observation group was higher than that of the control group (P<0.05). The increase range of nasolabial angle, decrease range of mentolabial sulcus depth, improvement range of soft tissue facial angle and improvement range of facial symmetry in the observation group after treatment were better than those in the control group (P<0.05). The operation satisfaction, status satisfaction and treatment effect satisfaction of the observation group were higher than those of the control group (P <0.05). Conclusion The application of facial soft tissue 3D reconstruction in orthodontics treatment can effectively improve the treatment status, optimize the facial aesthetic effect, enhance the improvement effect of facial soft tissue morphology, and improve patient satisfaction.