Objective To explore the effect of refined nursing with dual pathways of nasal cleansing and scar management on nasal ventilation function in patients after open septoplasty. Methods A total of 88 patients undergoing open septoplasty in the No.2 People’s Hospital of Lanzhou from January 2024 to December 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 44 patients in each group. The control group was given conventional nursing, and the observation group was given refined nursing with dual pathways of nasal cleansing and scar management on the basis of the conventional nursing. The nasal ventilation function, appearance recovery, scar status and adverse events were compared between the two groups. Results At 12 weeks after operation, the NOSE score and NR of the observation group were lower than those of the control group, while the MCA was larger than that of the control group (P <0.05). The VSS scores of the observation group at 4 and 12 weeks after operation were lower than those of the control group, the ROE score at 12 weeks after operation was higher than that of the control group, and the scar width was narrower than that of the control group (P <0.05). There were no statistically significant differences in the incidence rates of persistent crusting, nasal adhesion, persistent incision redness and itching, and hypertrophic scars between the two groups (P >0.05). The total incidence of adverse events in the observation group (1 1.36%) was lower than that in the control group (31.82%) (P <0.05). Conclusion Refined nursing with dual pathways of nasal cleansing and scar management can promote the recovery of nasal ventilation function in patients after open septoplasty, help to improve the scar of columellar incision, facilitate nasal appearancerecovery, and reduce the risk of adverse events.