While perforating lateral osteotomies have been previously described by other authors, most of the current literature emphasizes only sliding lateral osteotomies. Therefore, we present our experience with 106 consecutive rhinoplasties performed with perforating lateral osteotomies with a minimum 2-year follow-up. The perforating lateral osteotomy technique used in these rhinoplasties is described in detail and is compared with those techniques previously reported for perforating lateral osteotomies in rhinoplasty. Anatomical considerations are discussed. The results with the perforating lateral osteotomy technique have been excellent and are also presented. We think that perforating lateral osteotomies are an important and useful part of the rhinoplasty armamentarium.