Objective To observe the effect of postauricular fascia combined with autologous auricular cartilage in primary rhinoplasty. Methods A total of 84 patients who underwent primary rhinoplasty in the Department of Plastic Surgery, Guangzhou Rosely Medical Aesthetics Hospital from February to December 2024 were selected, and they were divided into the reference group and the study group by the random number table method, with 42 patients in each group. The reference group underwent rhinoplasty with simple autologous auricular cartilage, and the study group underwent rhinoplasty with postauricular fascia combined with autologous auricular cartilage. The surgical related indicators, nasal morphology improvement, complication rate, pain degree and satisfaction were compared between the two groups. Results The operation time of the study group was longer than that of the reference group (P <0.05). There were no significant differences in intraoperative blood loss and hospitalization time between the two groups (P >0.05). The nasal dorsum height, nasal tip projection and columella-philtral angle in the study group at 6 months after operation were better than those in the reference group (P <0.05). The incidence of complications in the study group (7.14%) was lower than that in the reference group (23.81%) (P <0.05). The VAS score of the study group at 7 days after operation was lower than that of the reference group (P <0.05). The satisfaction scores of the study group were all higher than those of the reference group (P <0.05). Conclusion In patients undergoing primary rhinoplasty, the application of postauricular fascia combined with autologous auricular cartilage will prolong the operation time, but achieves an ideal effect in improving nasal appearance. It can effectively ensure the aesthetic and natural appearance of the nose, with good safety. It will not increase intraoperative blood loss or prolong the hospital stay.