PURPOSE: Creating precisely controlled and consistent osteotomies of the nasal bones is one of the most difficult aspects of rhinoplasty. Most commonly, these osteotomies are performed with an osteotome and mallet in either a sweeping or perforating manner. Use of the osteotome, however, has resulted in a number of complications of varying degrees. A recent review of the literature has demonstrated aesthetic complications that include incomplete, asymmetric and irregular fracturing. This can result in a bony step-off and a contour deformity. More serious complications have been documented as well, including nasolacrimal duct injury and even subarachnoid hemorrhage. The senior author first introduced a safe and consistently reliable technique for nasal bone osteotomy 21 years ago. For the last 21 years, a dual plane curved stainless steel reciprocating saw blade has been used to accurately create osteotomies during primary rhinoplasty, secondary rhinoplasty and delayed nasal bone fracture reduction. The purpose of this paper is to provide long-term follow-up on a single surgeon's experience with this technique. Complications were reviewed and patient outcome data were collected. In addition, the entire procedure was recorded first on a cadaver and subsequently on a live patient in high definition video. METHOD: All patients in the senior author's practice who required a nasal bone osteotomy as part of their rhinoplasty since 1987 were treated with the following technique. A small stab incision was made in the nasal vestibule through which a subperiosteal pocket was dissected. Dissection in this plane was continued superiorly along the nasomaxillary suture to the level of the medial canthus. A dual plane reciprocating saw blade was then placed into this pocket in the proper position. Confirmation of precise positioning was performed by manual palpation of the blade beneath the skin. The osteotomy was performed easily, in a controlled manner, using a reciprocating power handle. A retrospective chart review was performed on all patients who underwent this procedure as part of their rhinoplasty between 1996 and 2008. Outcomes evaluated included major complications, degree of ecchymosis, final nasal contour and final bony alignment. In addition, pre and postoperative photographs were analyzed to evaluate the final aesthetic results. Patient satisfaction surveys were also used to assess the following postoperative outcomes from the patient's perspective: edema, ecchymosis, pain, discomfort, time elapsed prior to returning to normal activities and final aesthetic result. Finally, a video recording of the procedure was created on both a cadaver and a patient in order to demonstrate the subtle points of this technique. RESULTS: 316 osteotomies were performed as described above by the senior author between 1996 and 2008. A retrospective chart review within this group of patients revealed that no significant long-term complications occurred. In addition, postoperative ecchymosis was noted to be minimal and nasal contour and bony alignment were noted to be good. These results were confirmed with a photographic comparison of the preoperative and postoperative nasal contour. Patient survey data revealed a high level of final aesthetic result satisfaction with a small amount of postoperative ecchymosis and a quick return to normal activity. Finally, cadaveric and live patient video recordings of the procedure demonstrate the precision, reliability and consistency of this technique. CONCLUSION: A nasal bone osteotomy performed with a dual plane curved stainless steel oscillating saw blade is a safe and consistently reliable procedure. Use of this technique allows the surgeon to have complete control over the precise location of the osteotomy. By utilizing this precision and control, both common and rare osteotomy complications are avoided. In addition, consistent aesthetically pleasing results can be easily achieved.