Septorhinoplasty in children carries the risk of growth disturbance of the nose and premaxilla. The open or external approach has the advantage that the cartilaginous nasal skeleton remains intact. This open approach enables the surgeon to excise dermoid cysts and to realign lower lateral cartilages (unilateral cleft) without disturbing the integrity of the cartilaginous skeleton. In our experience, absolute indications for open rhinoplasty in children include dermoid cyst, cleft lip nose, and septal abscess. Relative indications include septal deviations causing severe nasal airway obstruction and or progressive distortion of the nose. In this article, we discuss the indications, advantages, disadvantages, and operative technique of open rhinoplasty in children. Our indications for open rhinoplasty in children and some selected cases are illustrated.