Objective To observe the effect of pedicle upper lip mucosal flap repair in patients with nasal septal mucosal defect after rhinoplasty. Methods A total of 78 patients with nasal septal mucosal defect after rhinoplasty who received treatment in the Plastic and Aesthetic Surgery Department of Shantou Yaliang Yuemeihui Medical Cosmetology Clinic from January 2023 to March 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 39 patients in each group. The control group was given traditional free mucosal graft repair, and the study group was given pedicle upper lip mucosal flap repair. The perioperative indicators, complication rate, functional recovery and aesthetic effect were compared between the two groups. Results The operation time, intraoperative blood loss, mucosal healing time and complete epithelialization time in the study group were better than those in the control group (P <0.05). The incidence of complications in the study group (5.13%) was lower than that in the control group (25.64%) (P <0.05). The scores of nasal ventilation function and olfactory function in the study group after treatment were higher than those in the control group (P <0.05). The physician aesthetic score and patient satisfaction score in the study group were higher than those in the control group (P <0.05). Conclusion The application of pedicle upper lip mucosal flap repair in patients with nasal septal mucosal defect after rhinoplasty has a definite effect, which can improve perioperative indicators, reduce complications, promote functional recovery, help to improve aesthetic effect, and is worthy of clinical application.