Objective To analyze the effect of perioperative nursing oriented by skin aesthetic needs on scar repair effect in patients undergoing endoscopic thyroidectomy. Methods A total of 70 patients undergoing endoscopic thyroidectomy admitted to Tai'an 88th Hospital from April 2023 to March 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 35 patients in each group. The control group received conventional perioperative nursing, and the observation group received perioperative nursing oriented by skin aesthetic needs. The scar repair effect, scar status, quality of life, skin satisfaction and adverse reactions were compared between the two groups. Results At 3 months after operation, the scar repair effect score of the observation group was lower than that of the control group (P<0.05). At 3 months after operation, the scores of scar pruritus, pain, paresthesia and contracture in the observation group were lower than those in the control group (P<0.05). At 3 months after operation, the quality of life score in the observation group was lower than that in the control group (P<0.05). At 3 months after operation, the skin satisfaction score of the observation group was higher than that of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Perioperative nursing oriented by skin aesthetic needs can effectively improve the scar repair effect and reduce scar pruritus in patients undergoing endoscopic thyroidectomy, without increasing adverse reactions, thus improving the quality of life and skin satisfaction