It also gave him his 12th ATP title, and, perhaps more importantly, his first for nearly three years since claiming victory at the Memphis Open in February 2016.
It was in the ninth game of the third set when Medvedev earned his second service break - half of what he created - which proved to be decisive as the Russian player held his following serve to post his second win over Raonic in their second career match. "I mean top players, champions of our sport", Medvedev said.
But Nishikori recovered to storm into a 5-1 lead in the decider and he soon wrapped up victory.
"I expected something like this before the match - I'd seen him play a couple of times and I knew it would be tough", Tsonga said. "For sure, [this year is] a better start because I feel this tournament is always the start of the year".
Nishikori said he was pleased with his form heading into the Australian Open, where he has never progressed further than the quarterfinals. He served out the set to level the match, 6-3.
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"I'm happy to go into Melbourne, one of my favourite tournaments there", he said.
"I think everything was against me today".
De Minaur, who announced himself with a semi-final charge in Brisbane 12 months ago, ran and ran in the second set as Tsonga blazed away.
Serving for the title at 5-4 Sunday, Tsurenko lost 13 straight points.
"I just tried to change the things around a little bit and believed I was going to get a chance".
"I didn't lose one serve in the match, and that was the key", said Medvedev, who secured his maiden ATP Tour title in Australia nearly 12 months ago at the Sydney International.