Open structure rhinoplasty combines the open(external) approach to rhinoplasty with innovative nasal restructuring techniques especially for the lower third of the nose. It involves minimal resection of the nasal structure, dome-dividing maneuvers with reconstitution of the lateral crural strip, and columellar strut and tip-grafting methods. A total of 14 patients are presented, 1 with congenital flat nose, 1 with congenital nasal deformity, 1 with congenital bulbous tip and deviation, and 11 with posttraumatic nasal deformities, with age between 14 and 41 years old and a follow-up period of 2 years. These patients underwent humpectomy, septal cartilage shield graft, corrective rhinoplasty, and augmentation rhinoplasty through a transverse midcolumellar incision with bilateral marginal incisions. These incisions provide the exposure necessary to precisely assemble a structurally sound nasal skeleton. The nasal tip graft and alar cartilage realignment are essential for determining nasal tip projection. We used sutured-in-place tip graft in 3 patients. The aesthetic results were excellent with improved nasal dorsal profile including nasal tip projection. The open structure rhinoplasty, however, has its disadvantages. The procedure is more time consuming, mainly because the nasal restructuring maneuvers and transcolumellar incision require meticulous execution. Nevertheless if proper techniques are used, columellar scar is rarely noticed and almost disappears with the lapse of time. In conclusion, unlike all closed techniques, the open approach to rhinoplasty permits accurate diagnosis and precise realignment of deformed nasal structures(both cartilage and bone) during the operation.