Aim External nasal valve dysfunction (EVD) is a common cause of nasal obstruction, with function unlikely to be restored with septoplasty or turbinoplasty alone. This study aimed to assess the effect of two rhinoplasty techniques developed to prevent and treat EVD: lateral crural tensioning with articulated alar rim grafts (LCT) and lateral crural strut grafts (LCSG), in primary and revision rhinoplasty. Methods A retrospective cohort study was conducted. Included patients received either LCT or LCSG, defined by changing trends in practice over time. Patient assessment occurred at baseline and at least 6 months post-surgery. The primary outcome was sensation of nasal obstruction, measured by a visual analogue scale, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and an ordinal questionnaire of nasal obstruction (6 categories). Secondary outcomes were nasal airflow (analysed by assessing nasal peak inspiratory flow (NPIF), nasal airway resistance (NAR), and minimum cross-sectional area (MCA)) and patient-perceived aesthetic (assessed via the Rhinoplasty Outcome Evaluation (ROE) questionnaire and a 13-point ordinal questionnaire). Results 203 primary and 108 revision rhinoplasty patients were included. Both techniques had positive effects on outcomes in primary and revision cases. In primary rhinoplasty, LCT was more effective than LCSG in improving nasal obstruction (≥1 category improvement: 81% vs. 64%; p<0.01), nasal airflow (ΔNPIF: 21.00±46.43L/min vs. 4.32±42.64L/min; p=0.01 and ΔNAR obstructed side: -0.29 [-0.71-0.03]Pa/cm3/s vs. -0.11 [-0.56-0.18]; p=0.03), and ROE score (42 [21-54] vs. 31 [13-46]; p=0.02). Both techniques were similar in revision rhinoplasty. Conclusion LCT offers additional benefits in improving nasal obstruction symptoms, nasal airflow, and quality-of-life while avoiding the risk of “airway crowding” and provides a reliable method to successfully correct EVD.