Background <p>The aim of this study is to compare piezoelectric osteotomy with conventional osteotomy in rhinoplasty using ultrasonographic techniques in terms of ICP and the measurement of the optic nerve sheath diameter (ONDM).</p> Methodology <p>A total of 40 patients who underwent rhinoplasty surgery were included in the study. The patients were randomly divided into two groups of 20. Conventional osteotomy was performed in the first group during surgery. Piezoelectric osteotomy was performed in the second group. ONDMs were measured. Prior to anesthesia induction, baseline ONDM was determined as ONDM-1. A total of five measurements were taken: after intubation (ONDM-2), immediately before hump resection and osteotomy (ONDM-3), immediately after osteotomy (ONDM-4), and immediately before extubation (ONDM-5).</p> Results <p>ONDM-2 was significantly larger than ONDM-1 in both groups. In group 1, significant differences were found between ONDM-2 and ONDM-4 (<i>p</i> &lt; 0.001) and between ONDM-3 and ONDM-4 (<i>p</i> &lt; 0.001). In the second group, significant differences were observed between ONDM-2 and ONDM-4 (<i>p</i> &lt; 0.001). No significant difference was observed between ONDM-3 and ONDM-4 (<i>p</i>= 0.694). Additionally, significant differences were found between the two groups in terms of ONDM-4 and ONDM-5 values (<i>p</i> &lt; 0.001, <i>p</i> = 0.011).</p> Conclusion <p>Both intubation and conventional osteotomy can increase ONDM, suggesting a possible increase in ICP in the conventional osteotomy group. In patients who underwent piezoelectric osteotomy, an increase in ONDM was observed only after intubation. This suggests that piezoelectric osteotomy is safer in terms of ICP.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>