Rhinoplasty5 pearls: value of the endonasal approach and vertical dome division.

Successful outcomes in rhinoplasty depend more on diagnosis than on approach or technique. When the needs of each patient are assessed on multiple occasions, operative performance improves and revision rates decline. The evolutionary track from an endonasal and excisional operation to the more commonly preferred external and restructuring technique is outlined in this article. The senior author's rationale and preference for the endonasal approach and the repositioning of cartilage in the tip using vertical dome division techniques is emphasized.