Objective To investigate the effect of nasal alar cartilage transplantation on postoperative shaping effect and nasal physiological function in patients with nasal tip hypertrophy plastic surgery. Methods A total of 82 patients with nasal tip hypertrophy admitted to Xi'an Ximu Medical Beauty Clinic from September 2022 to November 2023 were selected as the research objects. According to different surgical methods, they were divided into control group and observation group, with 41 patients in each group. The control group was treated with open nasal tip suture, and the observation group was treated with nasal alar cartilage transplantation. The nasal shaping effect, nasal physiological function, complications and plastic satisfaction were compared between the two groups. Results The nasal length, nasal tip height and nasal tip distance in the observation group were better than those in the control group (P <0.05). There was no significant difference in postoperative nasal cilia movement rate and nasal resistance between the two groups (P >0.05). The incidence of complications in the observation group was 4.88%, which was lower than 19.51% in the control group (P <0.05). The plastic satisfaction of the observation group was 92.68%, which was higher than 75.61% of the control group (P <0.05). Conclusion Nasal alar cartilage transplantation is effective in patients with nasal tip hypertrophy, which can improve the satisfaction of patients with plastic surgery, and does not affect the physiological function of patients' nose. It is safe and worthy of clinical application.