Piezosurgery is appropriate for all bony surgeries, but it is predominantly helpful when access is limited and/or the bones are close subtle soft tissue, Aim and objectives; this work aimed for comparing conservative osteotomies and rasping with the Piezosurgery medical device, as regard operative time, post-operative edema, ecchymosis, and pains in open rhinoplasty patients. Subjects and methods: It is a prospective study done at our university hospital from June 2019 to December 2020. This study included 40 patients, 20 done with Piezosurgery technique in osteotomy and rasping, other 20 with conventional technique in osteotomy and rasping. This study involves both males and females their age range from 18-50 years, informed consent taken. Results: Postoperative ecchymosis was statistically significant in 2nd and 4th day’s postoperative, Piezosurgery better than conventional osteotomy and rasping (p <0.05), but in 7th day no significant difference between both techniques (p= 1.00), Conclusion: Piezosurgery is a safe, feasible, and helpful technique for accomplishment of lateral osteotomy and rasping in rhinoplasty. The Piezo electrical medical device concentrates the action completely on mineralized tissue therefore protecting the nasal mucosa. Piezosurgery is accompanying with reduced severity of edema and ecchymosis, and pain in comparison to conservative osteotomy.