Current updates in nasal bone reshaping

To review recent studies on nasal osseocartilaginous anatomy, osteotomy techniques and contemporary methods of nasal bone reshaping carried out under direct vision. Current cadaver studies on osseocartilaginous vault anatomy, osteotomy techniques provide valuable information that can reduce outcome variability and increase reliability of osteotomies. Nevertheless, osteotomes have limitations and contemporary approaches - namely, piezoelectric instrumentations, osteoectomy, and osteotomy carried out under direct vision - can provide valuable solutions to certain shortcomings. Contrary to widespread understanding, extended wide periosteal dissection is the common thread in newly introduced methods which claim enhanced control, reduced soft tissue trauma, and reproducible results. Comparative and cadaver studies show promising results regarding protection of underlying mucosa, reduced comminuted fractures, reduced postoperative ecchymosis, and edema. Improvements in nasal bone reshaping are promising for better esthetic and functional outcomes. Nevertheless, these approaches need to be validated by randomized controlled trials and test of time before being incorporated in routine surgical practice.