Objectives Rhinitis medicamentosa is a challenging condition resulting from prolonged nasal decongestant use. This study aimed to compare holmium laser turbinate reduction and partial turbinoplasty surgical options. Methods A retrospective cohort study was conducted, including 65 patients diagnosed with rhinitis medicamentosa, with a minimum post-operative follow up of 12 months. Symptom severity and quality of life were assessed pre- and post-operatively using the Sino-Nasal Outcome Test 22 (SNOT-22) and the visual analogue scale (VAS). Results Both surgical techniques resulted in significant post-operative improvement in SNOT-22 and VAS scores. Post-operative SNOT-22 total and obstruction scores were significantly lower in the partial turbinoplasty group compared with the holmium laser turbinate reduction group (p < 0.05). Post-operative VAS scores did not differ significantly between groups (p > 0.05). The partial turbinoplasty group demonstrated higher incidence of early post-operative complications. Conclusion Both holmium laser turbinate reduction and partial turbinoplasty are effective surgical options for rhinitis medicamentosa. Surgical technique selection should be individualised based on disease severity, patient expectations and risk tolerance.