Objective To explore the clinical effect of prosthesis removal combined with autologous fat grafting in the correction of post-rhinoplasty deformity, and analyze its improvement on nasal dorsum smoothness. Methods A total of 66 patients with postrhinoplasty deformity admitted to our hospital from January 2025 to January 2026 were selected, and they were divided into the control group and the observation group by the random number table method, with 33 patients in each group. The control group received simple prosthesis removal, and the observation group received prosthesis removal combined with autologous fat grafting. The clinical efficacy, nasal dorsum smoothness, satisfaction and complications were compared between the two groups. Results The total effective rate of correction in the observation group (96.97%) was higher than that in the control group (78.79%) (P <0.05). The nasal dorsum smoothness score of the two groups at 6 months after operation was higher than that before operation, and that in the observation group was higher than that in the control group (P <0.05). The satisfaction rate of the observation group was higher than that of 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). Conclusion Prosthesis removal combined with autologous fat grafting can effectively correct post-rhinoplasty nasal deformity, improve the nasal dorsum smoothness and overall nasal aesthetic morphology, with high patient satisfaction and low incidence of complications.