The Authors report their personal experience relating to 51 cases of nose plastic surgery using an external trans-columella access route. From an evaluation of results, it emerges that by allowing full exposure of the nasal cartilaginous structure, this technique is ideally suited to the treatment of congenital deformities, and post-traumatic and iatrogenic consequences. Given the good esthetic results of the cutaneous scar, with which all subjects were satisfied, this method might also be proposed in selected cases of nose plastic surgery for esthetic reasons. Extremely pointed, bifurcate or bulbous nose can easily be treated given the direct and "dynamic" view of the anatomic peculiarities present. In conclusion, the advantages offered by external access outweight its "invasiveness", which appears to be more theoretical than that observed during follow up.