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The last decade has seen a marked increase in the use of the external approach for primary and secondary rhinoplasties. As a consequence, endonasal techniques are taught less and the external approach is increasingly being used for minor corrections. We review the infracartilaginous approach as an elegant variant of the endonasal approach and, for many procedures, a suitable alternative to the external approach and describe the technique of the infracartilaginous approach and illustrate its options with cases that, for the majority of rhinoplasty surgeons, would call for an external approach. We adopted the infracartilaginous approach as the preferred technique for most tip sculpting and repositioning procedures. The infracartilaginous approach is technically more challenging compared with the open approach in teaching situations. This, however, does not imply that the technique should therefore be abandoned. On the contrary, we are convinced that the technique can and should be taught and learned.