This study aims to explore the suture effectiveness of butterfly suture combined the looped, broad, and deep buried suture (butterfly tension-reducing suture) in patients with pigmented naevus. A retrospective analysis of patients with pigmented naevus from January 2021 to December 2022 were performed. Patients were divided into: (1) control group that received routine suture
(2) observation group receiving butterfly tension-reducing suture. The ratio of scar area to the naevus area, the scar width and the incision complication were investigated. Vancouver Scar Scale scores of patients (VSS), Patient Scar Assessment Scale (PSAS) and the Observer Scar Assessment Scale (OSAS) at pre-operation and 6 months after surgery were compared. Logistic regression analysis was used for the risk factor analysis of post-operative scars. The study included 34 in control group and 41 in observation group. Observation group showed a lower incidence of incision complication and smaller scar width. At 6 months after surgery, VSS items showed statistical changes between the control and observation group, including pigmentation, vascularity, pliability, height, and total opinion. Using PSAS, observation group showed lower scores in color, stiffness, thickness, irregularity, pain, itch, and overall opinion as compared to control group. There were significant decreases in OSAS items of the observation group compared to the control group, including vascularity, thickness, pigmentation, pliability, relief, and overall opinion. Suture method and incision complication were the risk factors of post-operative scars. Butterfly tension-reducing suture improves aesthetics and prognosis in pigmented naevus patients by inhibiting extension excessive tension.