M. Laurent Castillo, MD
Professor of Clinical Otolaryngology – Head and neck surgery
Head and neck institute

M. Charles Savoldelli, MD
Fellow of Oral and Maxillofacial surgery
University of Nice Sophia-Antipolis, France
Head and neck institute

The internal approach in rhinoplasty requires a surgical experience and an artistic perspective to provide adequate results on nasal deformities. The external approach allows cartilage shaping and grafting through a wider exposition of the entire nasal structure (bones and cartilages), but leaves a columellar scar. The wide marginal approach is known as open rhinoplasty without skin-columella incision. It was first described by guerrerosantos [1] in 1987. This procedure was originally introduced to lessen the complications seen with the open approach, while keeping the advantages of a better exposition insufficient with closed rhinoplasties. Although scarcely discussed in the literature, this approach can be proposed to a patient refusing the open approach when needed to address difficult tips.