Vegetation on the Southwestern Tibetan Plateau (SWTP) is critical to ensuring ecological security and promoting regional economic and social development. Here, we explored the relationship between topographic factors (elevation, slope, and aspect) and the spatial patterns in the normalized difference vegetation index (NDVI) in the SWTP over the past 20 years. The results found that the NDVI in the SWTP was primarily influenced by elevation and slope. The regions with significant variations in NDVI were concentrated between 4500 m to 5500 m and slopes ranging from 0° to 15°. Although the influence of aspect on NDVI was small, there was a decreasing trend in NDVI on sunny slopes and an increasing trend on shady slopes. Dominant topographic conditions were identified by considering 230 different combinations of elevation, slope, and aspect. The combination of topographic parameters indicated stronger patterns in NDVI variability, notably within sections of 0°–25°slopes and below 5000 m elevation. These findings highlight the relevance of topography, notably slope and aspect, for vegetation in alpine settings. The information gathered from this study about the prevailing topographic distribution and vegetation growth state in the SWTP can help with future ecological restoration and conservation efforts in the Tibetan Plateau and other comparable regions worldwide.