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To retrospectively analyze the off‐label prescriptions at a plastic surgery hospital in China and conduct a literature review. The prescriptions in outpatient department from January 1, 2018 to December 31, 2018 were collected and compared with the related drug instructions in indications, dosage, frequency and route of administration to identify the off‐label prescriptions. According to related literatures, guidelines, and MICROMEDEX, the rationality of off‐label drug uses was evaluated. A total of 39 836 prescriptions were screened and 3395 (8.52%) off‐label prescriptions were identified. It involved 23 items off‐label medication uses. 20 items were off‐label used in indication and three items were in indication and administration route. These off‐label prescriptions involved 19 medicines and 12 indications and the dermatology related drug usage accounted for the largest proportion (91.3%). Additionally, five items (21.7%) were Chinese patent medicine related. Of the 23 items, seven (30.4%) have been recommended by guidelines and two (8.7%) by Thomson Grading System of Micromedex. All of them have been proved by literature evidence of level 1 to 4, in which 19 (82.6%) by Level 1 evidence, 21 (91.3%) by Level 1 to 2 evidence and 2 (8.7%) only by level 3 to 4 evidence. This can provide a theoretical basis to clinicians in prescribing. Our next work is to perfect some details about evidence assessment to improve the reliability. [ABSTRACT FROM AUTHOR]