Introduction

In the modern era of rhinoplasty, the introduction of external rhinoplasty was greeted by enthusiastic advocates and also met with spirited opposition. Over time, however, the tenor of this debate has become more ecumenical. Most surgeons now recognize the broad utility of both endonasal and external approaches. Most understand that there are situations when a given approach offers advantages and may be considered preferable. Most also agree that there is a large “grey area,” where either the endonasal or the external approach would be appropriate, and the choice may be considered a “toss-up.” Most surgeons readily acknowledge that surgeon comfort with a procedure is an appropriately important factor.

In this chapter we will …review the various approaches and discuss general indications for the external approach and for the endonasal approaches. We will discuss the pros and cons of each approach, and provide further thoughts on the decision making process.