To perform medial osteotomies, insert the osteotome at the junction between the nasal bone and septum. With the two-tap technique, advance the cutting edge cephalad and fade laterally as the frontal bone is reached (Fig. 1). Control the sharp leading edge of the chisel, as it moves under the skin, with the forefinger of the nondominant hand. This fading me- dial osteotomy avoids the thick frontal bone. Medial osteotomies are usually not necessary in cases in which large dorsal humps are excised, leaving an open-roof deformity.