OBJECTIVE The purpose of this study was to perform a systematic review and meta-analysis of complications after orthognathic surgery comparing piezo-surgery with conventional osteotomy. METHODS We conducted this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a systematic search of PubMed, Scopus, Science Direct, Lilacs, Cochrane Central Register of Controlled Trials, Google Scholar, and OpenThesis to identify randomized and nonrandomized controlled trials (RCTs and nRCTs, respectively) comparing patient outcomes (operative time, intraoperative blood loss, postoperative swelling, pain, neurosensitivity) after orthognathic surgery by piezoelectric or conventional osteotomy. We pooled individual results of continuous and dichotomous outcome data using the mean difference (MD) and risk difference (RD) with the 95% confidence interval, respectively. RESULTS Three RCTs and five nRCTs were selected. No difference in operative time was observed between piezo-surgery and conventional osteotomies. We found a decrease of intraoperative blood loss with piezo-surgery (MD -128 mL; P < 0.001) and a pooled difference in severe blood loss of 35% (P = 0.008) favouring piezo-surgery. Based on pooled individual results of studies evaluating neurosensitivity by clinical neurosensory testing, our meta-analysis showed a pooled difference in severe nerve disturbance of 25% (P < 0.0001) favouring piezo-surgery. Test for subgroup differences (I2 = 26.6%) indicated that follow-up time may have an effect on neurosensory disturbance. We found differences between piezo-surgery and conventional osteotomy at 3 months (RD 28%; P < 0.001) and 6 months (RD 15%; P = 0.001) after surgery. Meta-analyses for pain and swelling were not performed because of a lack of sufficient studies. CONCLUSIONS Currently available evidence suggests that piezo-surgery has favorable effects on complications associated with orthognathic surgery, including reductions in intraoperative blood loss and severe nerve disturbance.