Osteotomy is the surgical cutting or division of bone, and its therapeutic use dates back to Hippocrates. It began to be used in bone lengthening surgery with Ilizarov`s description of distraction osteogenesis. Low-energy osteotomies are preferred in bone lengthening surgery; they promote bone healing by preserving periosteal and endosteal circulation. Corticotomy (Ilizarov technique) allows for the use of a motor-free osteotomy while preserving periosteal and endosteal circulation. Multidrill hole osteotomy (De Bastiani technique) creates a more planned osteotomy line than corticotomy osteotomy and carries a lower risk of unintended fractures. Gigli saw osteotomy (Afghan technique) creates a straight osteotomy line through the subperiosteal tunnel. It is particularly used in derotation surgeries but is technically more challenging. In all techniques, minimal approaches that respect soft tissue and the correct selection of the osteotomy site ensure successful outcomes in bone lengthening surgery.