Objective To explore the effect of costal cartilage cortex scaffold on nasal three-dimensional indexes, nasal ventilation function and nasal aesthetic indexes in patients undergoing rhinoplasty. Methods A total of 113 patients who underwent rhinoplasty and were admitted to Chongqing Huamei Plastic Surgery Hospital from January to December 2023 were selected as the research samples. According to the random number table method, they were divided into the control group (57 patients) and the observation group (56 patients). The control group received costal cartilage medullary slice scaffold, and the observation group received costal cartilage cortex scaffold. The nasal three-dimensional indexes, nasal ventilation function, nasal aesthetic indexes, complications and plastic surgery satisfaction were compared between the two groups. Results The nasal length, nasal tip protrusion and the distance between the left and right nasal tip vertices in the observation group were higher than those in the control group (P<0.05). The difference of nasal minimum cross-sectional area and the difference of nasal cavity volume in the observation group were higher than those in the control group, and the difference of nasal exhalation and inhalation resistance in the observation group was lower than that in the control group (P <0.05). The nasofacial angle, nasolabial angle and nasofrontal angle in the observation group were all higher than those in the control group (P <0.05). The incidence of complications in the observation group was lower than that in the control group (P <0.05). The plastic surgery satisfaction scores of nostril, nasal tip and nasal shape in the observation group were higher than those in the control group (P<0.05). Conclusion Costal cartilage cortex scaffold in rhinoplasty can optimize the nasal three-dimensional indexes, improve the nasal ventilation function, enhance the nasal aesthetics, and reduce the negative impact on the body, resulting in higher patient satisfaction.