Background <p>Osteotomy is a critical component of rhinoplasty but is associated with postoperative morbidity, including pain, edema, ecchymosis, and subconjunctival hemorrhage.</p> Aim <p>This study compares the outcomes of three osteotomy techniques—conventional, magic saw, and piezoelectric—in terms of operative performance and postoperative morbidity.</p> Methods <p>In this single-blinded, randomized trial, sixty individuals of Caucasian Mediterranean ethnicity underwent primary septorhinoplasty at Mansoura University Hospital (2022–2024). Patients were randomized into three groups (<i>n</i> = 20 each): Group 1 (conventional osteotomy), Group 2 (magic saw), and Group 3 (piezoelectric). All surgeries followed a standardized open rhinoplasty approach. Postoperative outcomes, including pain (VAS score), periorbital edema, ecchymosis, and subconjunctival hemorrhage, were assessed on days 1, 7, and 21. Functional and aesthetic results were evaluated using NOSE and SCHNOS scores at baseline, 1 month, and 6 months postoperatively.</p> Results <p>Piezoelectric osteotomy resulted in significantly lower pain, edema, ecchymosis, and subconjunctival hemorrhage on day 1 compared to conventional and magic saw techniques (<i>p</i> &lt; 0.05). By day 7, no significant differences remained among groups. All patients showed complete resolution of early complications by day 21. SCHNOS and NOSE scores improved significantly in all groups over time, with no intergroup differences at 6 months.</p> Conclusion <p>Piezoelectric osteotomy demonstrates superior short-term outcomes in reducing postoperative morbidity but requires longer operative time. Magic saws also reduce early complications relative to conventional techniques, though less consistently. Despite differences in early recovery profiles, all three techniques yield comparable long-term functional and aesthetic outcomes.</p>