Objective To explore the effect of cosmetic suture on scar formation in emergency patients with facial skin and soft tissue injury. Methods A total of 78 emergency patients with facial skin and soft tissue injury admitted to the Department of Emergency, Zhenjiang Hospital of Chinese Traditional and Western Medicine from March 2022 to February 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 39 patients in each group. The control group received routine debridement and suture, and the observation group received cosmetic suture. The clinical efficacy, functional status recovery, wound healing status and scar formation were compared between the two groups. Results The total effective rate of the observation group was 97.44%, which was higher than 82.05% of the control group (P <0.05). The scores of functional status recovery in the observation group after treatment were higher than those in the control group (P <0.05). The wound healing time and postoperative healing status of the observation group after treatment were better than those of the control group (P <0.05). The scar formation of the observation group after treatment was milder than that of the control group (P <0.05). Conclusion In the emergency treatment of facial skin and soft tissue injury, the application of cosmetic suture can not only effectively improve wound healing and scar formation, but also promote the recovery of functional status, thereby improving the overall treatment effect.