Edema affects outcomes in Rhinoplasty. Edema and bruising influences patient satisfaction in the perioperative period. A qualitative analysis of edema comparing piezoelectric and conventional osteotome, and a qualitative comparison of bruising between these methods. A prospective cohort study of 31 aesthetic Rhinoplasty cases. Participants act as their own control measure. An osteotome is used on one side of the nasal bone and a piezoelectric is used contralaterally. Edema is calculated by comparing a pre and post-operative 3-D image with volumetric analysis. Ecchymosis is scored and compared. The mean volume of the piezoelectric was 1.37 cc (SD 0.87) and the mean volume of the osteotome was 1.17 cc (SD 0.70) (0.19 absolute difference 95 % CI 0.3 to 0.35, p = 0.02). Bruising scores were 0.35 points lower for the piezoelectric arm (−0.35 absolute difference 95%CI -0.7 to 0.06, p < 0.01). This corresponded to 26 % of lateral piezo osteotomies having significant bruising compared to 38 % of the lateral osteotomies using the conventional technique. There is a difference in postoperative edema and bruising with the piezoelectric and conventional osteotome for lateral osteoetomy in Rhinoplasty. There is more edema with the piezoelectric and more ecchymosis with the conventional osteotome. •Question: Is edema and bruising different with piezoelectric osteotomy during rhinoplasty?•Findings: Edema is greater with the piezoelectric and bruising is less with the piezoelectric.•Meaning: The piezoelectric has a different healing profile with regards to edema and bruising than the conventional osteotome in rhinoplasty.