Lateral osteotomy is a controversial step in rhinoplasty, which is usually performed to narrow a wide nose, widen a narrow bony pyramid, straighten a deviated nose, or close an open roof deformity. The osteotomy is performed using several methods, although the internal continuous and external perforator are the main ways to perform the lateral osteotomy. Most other techniques are modifications of these basic methods. The purpose of this article is to review the essential concepts of nasal hump surgery and lateral osteotomy as used in cosmetic rhinoplasty.