Background <p>Nasal obstruction is a prevalent condition that significantly impacts patients’ quality of life. Surgical interventions such as spreader grafts and auto-spreader flaps have been developed to address internal nasal valve dysfunction, but their comparative effectiveness remains unclear. This study aims to compare the effectiveness of the spreader graft and auto-spreader flap techniques in relieving nasal obstruction in patients undergoing septorhinoplasty.</p> Methods <p>A total of 60 patients with nasal obstruction were randomly assigned to two groups, receiving either the spreader graft or auto-spreader flap technique during septorhinoplasty. The NOSE scale was administered preoperatively, and at one month and six months postoperatively, to assess nasal obstruction symptoms.</p> Results <p>Both surgical techniques led to significant improvements in nasal obstruction symptoms, as measured by the NOSE scale, with improvements observed in congestion, blockage, breathing difficulties, and sleep disturbances. No significant differences were found between the two groups at any time point. The overall NOSE scores decreased significantly from baseline to six months post-surgery in both groups (spreader graft: 70 ± 7.7 to 30.85 ± 4.75; auto-spreader flap: 69.5 ± 9.45 to 31.5 ± 6.6), with no significant differences between the two techniques.</p> Conclusion <p>Both the spreader graft and auto-spreader flap techniques are equally effective in alleviating nasal obstruction in patients undergoing septorhinoplasty, however, the differences are not statistically significant. The choice of technique should be individualized based on patient anatomy, surgeon experience, and specific surgical goals, rather than routine preference.</p>