Objective To explore the effect of endoscope-assisted functional rhinoplasty on nasal valve function and nasal aesthetics in patients with nasal septal deviation complicated with wry nose deformity. Methods A total of 80 patients with nasal septal deviation complicated with wry nose deformity admitted to Xinjiang Vcharm Plastic Surgery Hospital from January 2023 to January 2025 were selected, and they were divided into the control group and the observation group according to different surgical methods, with 40 patients in each group. The control group was given endoscopic nasal septum correction, and the observation group was given endoscope-assisted functional rhinoplasty. The nasal obstruction status, nasal valve function, nasal aesthetics and clinical efffcacy were compared between the two groups, and the correlation between the improvement value of NOSE score and the improvement value of ROE score was analyzed. Results The NOSE score of the observation group at 6 months after surgery was lower than that of the control group (P<0.05). The total nasal resistance and MCA of the observation group at 6 months after surgery were better than those of the control group (P<0.05). The scores of NAES and ROE in the observation group at 6 months after surgery were higher than those in the control group (P<0.05). The total effective rate of the observation group was higher than that of the control group (P<0.05). The improvement value of NOSE score was positively correlated with the improvement value of ROE score (P<0.05). Conclusion Endoscope-assisted functional rhinoplasty can effectively improve the nasal valve function and nasal aesthetic shape of patients, while alleviating nasal obstruction symptoms, with good overall clinical efficacy. The positive correlation between the improvement value of NOSE score (reflecting nasal obstruction) and the improvement value of ROE score (representing nasal aesthetics) further confirms the consistency of functional and aesthetic improvement.