For some time now, gold standard management of the maxillary sinus inverted papilloma has been endoscopic medial maxillectomy (EMM). Recently the endoscopic prelacrimal recess approach (EPLRA) has been reported to provide good access whilst preserving the nasolacrimal duct and inferior turbinate, and this paper looks to compare the recurrence rates for the two types of surgery. Eighteen studies were analysed, involving a total of 501 patients, comparing a number of different types of surgery to treat inverted papilloma, including EMM, EPRLA, and also simple middle meatal antrostomy and Caldwell-Luc approach. Unsurprisingly, the EPLRA approach demonstrated lower rates of recurrence than middle meatal antrostomy either with or without a Caldwell-Luc approach. The EPLRA approach showed a similar recurrence rate (3%) to EMM, and allowed access to lacrimal recess which may otherwise be difficult. Ultimately, the benefits are preservation of the nasolacrimal duct and inferior turbinate avoiding the potential complications of crusting and epiphora, however the EPLRA approach adds the potential complications of facial and gingival numbness, or alar collapse. The choice is yours!