Objective. To develop a rhinoplasty technique with preserved nasal bony vault stability using piezoelectric devices and rhinosculpture alone and in combination with various osteotomies.

Material and methods. We used a step-by-step algorithm depending on severity of bone pyramid asymmetry. In all cases, open approach was preferred due to large visualization area during all stages associated with correction of the bony vault. Rhinosculpture alone and in combination with various osteotomies was performed to stabilize the nasal bones.

Results. There were 300 rhinoplasty surgeries for the period from December 2016 to December 2019 (36 months). Patients were divided into 5 groups depending on the algorithm for treating the bone pyramid. The last one directly depended on severity of bone vault asymmetry.

Conclusion. The proposed technique limits mobility of nasal bony vault. Therefore, nasal vault stability in short- and long-term period is associated with improved aesthetic and functional outcomes.

Keywords. rhinoplasty, rhinosculpture, piezoelectric instruments, osteotomy, nasal bony vault