Rhinoplasty is not only an approach to modify the nose, but it is also a surgical philosophy. Though the open approach offers a better view on the nasal skeleton, helping in teaching the surgical techniques and making some procedures easier, both the endonasal and open approaches require a precise anatomic knowledge. Nowadays, different surgical options in primary rhinoplasties are offered to the surgeons: preservation, structure, or resection. Rhinoplasty is not only a skeleton procedure. Soft tissues are also involved in the decision-making and in the postoperative follow-up. Is there something new about these tissues and their approaches?