Objective To analyze the effect of autologous cartilage rhinoplasty in patients with congenital nasal deformity. Methods A total of 54 patients with congenital nasal deformity admitted to our hospital from April 2021 to December 2023 were selected as the research objects. They were divided into reference group and analysis group by random number table method, with 27 patients in each group. The reference group was treated with silicone prosthesis rhinoplasty, and the analysis group was treated with autologous cartilage rhinoplasty. The nasal related measurement parameters, incidence of adverse surgical outcomes, incidence of complications and satisfaction with plastic effects were compared between the two groups. Results After treatment, the nasal width, nasal tip height and nasal protrusion angle of the analysis group were better than those of the reference group, the difference was statistically significant (P <0.05). The incidence of adverse surgical outcomes in the analysis group was 0, which was lower than 14.81% in the reference group, the difference was statistically significant (P <0.05). The incidence of complications in the analysis group was 3.70 %, which was lower than 25.93 % in the reference group, the difference was statistically significant (P <0.05). The satisfaction degree of plastic effect in the analysis group was 96.30%, which was higher than 74.07% in the reference group, the difference was statistically significant (P <0.05). Conclusion Autologous cartilage rhinoplasty is superior to silicone prosthesis rhinoplasty in the treatment of congenital nasal deformity, which can effectively improve the nose.