This chapter discusses open or external septorhinoplasty approach, where the direct visualization of the cartilaginous and bony framework of the nose provided by the open rhinoplasty approach enables accurate diagnosis and precise correction of the underlying nasal deformity. The indications for an open rhinoplasty approach are unique for each patient and surgeon depending on the surgeon’s technique and experience. A relative contraindication may be previous rhinoplasty or nasal surgery in which the dermal tissues of the skin soft-tissue envelope (S-STE) have been thinned excessively, potentially having compromised the subdermal plexus blood supply. Most rhinoplasty patients are treated on an outpatient basis using a general anesthetic or intravenous sedation anesthesia. The upper lateral cartilages may be sharply dissected from the septum if extensive work in the middle third of the nose is anticipated.