We partition this discussion of revisional surgery based on perceived problems with the primary rhinoplasty. This will focus on either underresection or overresection of tissues and the ensuing clinical result. We also discuss some select problems associated with manipulation of tissues via suturing or grafting and briefly discuss functional considerations in secondary surgery. We advocate an open approach when performing most revision rhinoplasty. Visualization and access provided by the open approach enables the surgeon to achieve treatment goals in a more predictable fashion, particularly in cases requiring extensive grafting or when a different surgeon performed the primary rhinoplasty.