The bony nasal pyramid, located in the upper one-third of the nose, is an important component of the nasal appearance. The correction of hump-nose deformity, deviated-nose deformity, and traumatic nasal deformity often involves the reconstruction and shaping of the bony nasal pyramid. Nasal osteotomy has existed since the inception of modern rhinoplasty. It is a classic rhinoplasty operation to achieve the purpose of shaping the bony nasal pyramid by incising and moving the bone with an osteotome. Nasal osteotomy is classified into lateral osteotomy, medial osteotomy, medial oblique osteotomy, intermediate osteotomy, and transverse osteotomy according to the osteotomy path. Traditional nasal osteotomy is performed under blind vision, with poor accuracy and a long learning curve. With the development of rhinoplasty techniques, endoscopic techniques, power equipment, and piezoelectric equipment have gradually been applied to nasal osteotomy, making nasal osteotomy visible and precise. Nasal osteotomy has also been integrated with the concept of preservation rhinoplasty to better play a functional protection role. This article introduces the anatomical basis, clinical classification, and the latest clinical progress of nasal osteotomy. At the same time, it also introduces the application and progress of nasal osteotomy in preservation rhinoplasty, providing a reference for rhinoplasty surgeons.