The reshaping of the nasal pyramid has evolved significantly over the past 20 years. Mechanical instruments have been refined to minimize the bone trauma of osteotomies. However, these instruments can inadvertently cause radiated fractures and comminuted fractures, which compromise bone stability and can create surface defects. Electric and piezoelectric instruments (PEI) have been developed to address these issues. PEI instruments are selective unlike electric instruments. These instruments allow for precise rhinosculpture and osteotomies under direct visual control. The article reviews the advantages and disadvantages of each method by comparing them for the most frequently performed procedures on the nasal bone pyramid in rhinoplasty.