Objective To explore the effect of facial refined nursing on facial aesthetics in patients with acne vulgaris. Methods A total of 80 patients with acne vulgaris admitted to the Department of Medical Cosmetology, Guigang Fourth People's Hospital/Guigang Skin Disease Prevention and Treatment Hospital from May 2024 to May 2025 were selected, and they were divided into the reference group and the observation group by the random number table method, with 40 patients in each group. The reference group received conventional nursing, and the observation group received facial reffned nursing. The skin appearance recovery time, acne severity, body image disturbance, facial aesthetics and recurrence rate were compared between the two groups. Results The acne pigmentation time and scar regression time in the observation group were shorter than those in the reference group (P<0.05). The GAGS score of the observation group after nursing was lower than that of the reference group (P<0.05). The SSBI score of the observation group after nursing was lower than that of the reference group (P<0.05). The facial aesthetics score of the observation group after nursing was higher than that of the reference group (P<0.05). The recurrence rate of the observation group was 2.50%, which was lower than 20.00% of the reference group (P<0.05). Conclusion The application of facial reffned nursing for patients with acne vulgaris can effectively improve skin appearance and promote the recovery of healthy skin status. This nursing method not only helps to reduce the severity of acne and alleviate patients' body image disturbance, but also enhances the overall facial aesthetics and reduces the recurrence rate of acne.