Aim The lateral crural strut graft (LCSG), while popular, does not always resolve external nasal valve dysfunction (EVD). Lateral crural tensioning and articulated alar rim grafts (LCT) can be an alternative when LCSG fails. This study aimed to investigate the effect of LCT as a salvage surgery in EVD when prior LCSGs have been used. Methods A case series of adult patients at a tertiary facial plastics clinic was conducted. Patients who had a prior LCSG and were revised with LCT by the same surgeon were included. Patients completed assessments at baseline and at least 6 months post-surgery. Assessment included a visual analogue scale (VAS) for nasal obstruction, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and an ordinal questionnaire of nasal obstruction. Nasal airflow was analysed by assessing nasal peak inspiratory flow (NPIF), nasal airway resistance (NAR), and minimum cross-sectional area (MCA). Patient-reported perceptions of nasal aesthetic was assessed via the Rhinoplasty Outcome Evaluation (ROE) questionnaire and a 13-point ordinal questionnaire of nasal aesthetic. Results 11 patients were assessed (36±10 years, 75% female). Total NAR and NAR of the obstructed side was reduced after conversion to tensioning (Δtotal NAR: -0.09±0.16Pa/cm3/s, ΔNAR obstructed side: -0.32±0.80Pa/cm3/s). Nasal MCA also saw an increase (Δtotal MCA: 0.07±0.23cm2, ΔMCA obstructed side: 0.05±0.14cm2). NPIF decreased by 7.50±42.72L/min. LCT patients improved in obstruction symptoms (ΔVAS; -13±32mm), but not by the NOSE questionnaire (ΔNOSE; 16±32). Perceptions of nasal aesthetic improved after LCT, with no patients complaining of poor aesthetic outcome post-operatively and an improvement in ROE score (ΔROE: 11±28). Conclusion This study suggests that LCT may be a good salvage manoeuvre for failed LCSGs for improving nasal resistance, cross-sectional area, and aesthetic outcome. However, the revision rhinoplasty patient complaining of obstruction remains a difficult case to resolve symptomatically.