From the Department of Facial Plastic Surgery, Modbury Public Hospital, Adelaide, South Australia.
In their desire to create more precise and less traumatic osteotomies, surgeons have created various new osteotome designs over the years. There is general agreement that a high/low/high osteotomy is the best technique to narrow the nose and to preserve the nasal airway. The frontal, or ascending process of the maxilla and the nasal bones themselves are quite delicate, being less than 3 mm in width over the area of the lateral osteotomy. Large osteotomies are easy to use but create additional damage to surrounding soft tissues and may cause a loss of support. Three-millimeter or 4-mm straight osteotomies can be used by expert surgeons to create precise osteotomies with minimal soft tissue damage. These osteotomies, however, are somewhat difficult to use, particularly for younger surgeons.
Floreani SR. The Flipper Osteotome. Arch Facial Plast Surg. 2000;2(3):221. doi: