Open-cage fullerene derivatives have excited organic chemists’ creativity over the past decade. These adducts, generated via consecutive cleavage of σ- and π-carbon–carbon bonds on the fullerene cage, allow small atoms or molecules to pass through their opening and be placed inside the cavity. Restoration of the ruptured fullerene back to the pristine fullerene cage affords the corresponding endohedral complexes. This “molecular surgery” approach has been proposed as an alternative to the synthesis of endohedral fullerenes via the conventional physical methods of production, which restrict the availability of endohedral fullerenes to milligram quantities after laborious isolation procedures. In this critical review, we survey all published techniques for the creation of an orifice, as well as for the expansion of an existing one, on the fullerene framework. Successful encapsulation experiments employing cage-opened fullerene derivatives are also comprehensively discussed (160 references).