Objective <p>To explore the effect of fine suturing combined with local flaps in the cosmetic repair of surgical defects associated with basal cell carcinoma (BCC) of the head and face.</p> Methods <p>A total of 46 patients with basal cell carcinoma of the head and face who were admitted to Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi) from January 2018 to June 2024 were retrospectively analysed. The patients were divided into a combined group and a control group, with 23 patients in each group. Each patient underwent extended tumour resection combined with intraoperative frozen section examination to ensure negative tumour boundaries. In the combined group, fine suturing and local flap transplantation were used to repair the defects; in the control group, traditional skin grafting was used to repair the defects. The perioperative indicators, postoperative scars, and patient satisfaction were compared between the two groups.</p> Results <p>The perioperative indicators of operation time and healing time were shorter than those of the control group (<i>P</i> &lt; 0.05), and the incidence of adverse reactions was lower than that of the control group (<i>P</i> &lt; 0.05). The Vancouver scar scale (VSS) score of the combined group was lower than that of the control group after follow-up for 6&#xa0;months to 2&#xa0;years, and patient satisfaction was higher (<i>P</i> &lt; 0.05).</p> Conclusion <p>Fine suturing combined with local flaps manifests a significant cosmetic effect in the repair of surgical defects of BCC of the head and face, which can reduce scar formation and improve patient satisfaction.</p>