MultiPatch is by far the best patch utility for Macs, working on modern versions of macOS and supporting all the major patch formats. I have not had any trouble with it at all, it works great and does the job as far as any of its supported formats. It supports both creating and applying patches for IPS, UPS, XDelta, BSDiff, and BPS, and it supports applying PPF patches although it cannot create them. It integrates very well into macOS, is user-friendly, works properly, and does things in a way Mac users find comfortable.

It is such a great program, there is really no need for any other patcher on Macs unless you are trying to use some obscure format it does not support, or, much more commonly, if you are trying to use a custom patcher executable that is Windows-only, such as the “CABBAGE.EXE” executable in the Radical Dreamers patch. In which case your best bet is to run the Windows-only patch on a Windows computer and then transfer the patched file back to your Mac, quite a shame that people make Windows-only patches sometimes.

Anyway, MultiPatch is also open-source and under the GNU GPL, and has been actively maintained for years, and whenever someone reports a problem it gets fixed. So really it is the best patcher for Macs and does not really have any real competition as far as patchers for macOS with native GUIs, although there are other patchers that are either command-line or have Java GUIs that can be run on a Mac.

Also, some people are claiming that the PPF support in MultiPatch is broken. This is wrong. Actually, the problem is, they are using old PPF patches for PlayStation games that only work in the emulator ePSXe and not in Mednafen, which is used as the PlayStation emulator core in the macOS emulator OpenEmu. The real problem is, the PPF patches in question are broken hacks that only work in the ePSXe emulator but not in accurate emulators or on real hardware. A similar problem happened in the past with IPS patches for SNES games that only work in the ZSNES emulator. MultiPatch works correctly. If your patches don’t work, you are probably using a patch designed for a legacy emulator like ePSXe or ZSNES. Luckily at least in the case of ePSXe it has a macOS version so just run the PPF patched PlayStation game on ePSXe instead of on OpenEmu if you have one of those old broken patches, and your problem is solved.