Objective To study the clinical effect of autologous costal cartilage transplantation combined with silicone rhinoplasty in nasal cosmetic plastic repair. Methods From June 2022 to June 2023, 60 patients with nasal cosmetic and plastic repair in Guangxi Aisite Plastic Surgery Hospital were selected and divided into control group and observation group according to different surgical methods, with 30 patients in each group. The control group was treated with silicone rhinoplasty, and the observation group was treated with autologous costal cartilage transplantation combined with silicone rhinoplasty. The rhinoplasty effect, complications and satisfaction of the two groups were compared. Results The scores of nasal aesthetics, nasal function, nasal congestion symptoms and mental state in the observation group were higher than those in the control group (P <0.05). The incidence of postoperative complications in the observation group was 6.67%, which was lower than 23.33% in the control group (P <0.05). The plastic satisfaction of the observation group was 93.33%, which was higher than 70.00% of the control group (P <0.05). Conclusion Autologous costal cartilage transplantation combined with silicone rhinoplasty has a good effect in nasal cosmetic plastic repair, which can improve nasal morphology, reduce the incidence of postoperative complications, and patients have a high overall satisfaction.