Ultrasonic (piezo) rhinoplasty is the method in which the nasal bones are cut and reshaped with an ultrasonic vibrating device. Ear, nose and throat specialist Op. Dr. Süleyman Kumbasar, whose practice is in Bahçelievler, Istanbul, uses piezo where a hump needs removing, the bone needs narrowing or an asymmetrical bony framework needs correcting. Systematic reviews report less swelling and bruising in the early period after surgery in most studies; in surgery limited to the tip, piezo is not needed.
What is ultrasonic rhinoplasty?
Ultrasonic (piezo) rhinoplasty is a rhinoplasty in which the nasal bones are reshaped with a device that works by ultrasonic vibration, instead of a hammer and chisel. It is not a different type of surgery, but a choice of the instrument used for the bony stage of the rhinoplasty.
The tip of the piezo device vibrates thousands of times per second and, while it cuts or files hard bone, it affects more elastic tissues such as soft tissue, blood vessels and mucosa relatively less. To prevent heating, the tip is cooled with saline throughout. If the septum or turbinates are also operated on in the same procedure, the combined surgery is called septorhinoplasty; the difference is explained in the article rhinoplasty vs septorhinoplasty.
When is it used?
Piezo is only used at the stage where the nasal bone has to be worked on:
- Removing a hump and smoothing the bridge of the nose
- Narrowing wide nasal bones (osteotomy)
- Correcting a crooked or asymmetrical bony framework
- In revisions, correcting bony irregularities from the previous operation (see revision rhinoplasty)
In surgery limited to the tip, the bone is not worked on and piezo is not needed (see tip rhinoplasty). The decision to use it is made at the consultation, according to how much the bony framework needs reshaping.
How is it different from the classic method?
In a classic osteotomy, the bone is reshaped by creating controlled fractures with a chisel and hammer. With piezo, the bone is cut and filed under direct vision. Because using piezo requires lifting the membrane that covers the bone over a wider area, it is usually combined with the open technique.
A systematic review of published randomised trials reports that, in most studies, early swelling and bruising after surgery were reduced with piezo osteotomies, as were pain and damage to the nasal lining. The same review notes as disadvantages that the operation may take longer and the cost may be higher. Results vary between patients; bruising and swelling can still occur when piezo is used.
What is assessed at the consultation?
At the consultation, Op. Dr. Süleyman Kumbasar assesses the size of the hump, the width and symmetry of the nasal bones, skin thickness and the internal structures of the nose with an endoscope. The use of piezo, the choice between open and closed technique and the need for septum or turbinate surgery are planned according to these findings. The steps of the examination are described in the article what is assessed at a rhinoplasty consultation.
What are the risks?
The risks of ultrasonic rhinoplasty are the same as those of rhinoplasty in general: bleeding, infection, anaesthetic risks, prolonged swelling, minor asymmetry and, rarely, breathing problems. If the open technique is needed, a fine scar remains on the columella. The risks are explained at the consultation before surgery and written informed consent is obtained.
The surgical process
General anaesthesia. An anaesthetic assessment and blood tests are carried out before the operation.
Depending on the scope, usually 2 to 3 hours; using piezo may make it slightly longer.
Piezo is usually used with the open technique; this is decided at the consultation.
Discharge on the same day or after one night in hospital; this is given at the planning stage.
Whether packing is used depends on the surgical plan. The splint is usually removed at the end of the first week.
Recovery timeline
Swelling and bruising are most visible during this period. Keeping the head raised and applying cold compresses is recommended.
The splint and stitches are removed; returning to office work is usually possible during this period.
Bruising has largely faded; recovery is enough for social life.
Usually the right time for light exercise and swimming; contact sports should wait at least 3 months.
Swelling goes down gradually; the final shape is assessed at month 12.
Frequently asked questions
Does piezo mean no bruising?
Bruising can still occur. Studies report that early bruising and swelling are reduced with piezo in most patients, but it cannot be said that they are avoided entirely. They depend on skin type, the extent of the bone work and each person’s healing.
Is piezo used in every rhinoplasty?
No. Piezo is only used when the nasal bone needs reshaping. It is not needed in tip surgery where the bone is not worked on.
Can ultrasonic rhinoplasty be done with the closed technique?
Because piezo needs a direct view of the bone over a wide area, it is usually used with the open technique. In some cases with limited bone work it is used with the closed technique; the choice is made at the consultation.
Does piezo make the operation longer?
Some studies report that the operation takes longer with piezo; the difference depends on the scope of the case and the surgeon’s experience. The expected duration is given before surgery.
Is recovery quicker with piezo?
Less early swelling and bruising can make returning to social life easier. However, the swelling of the tip settling and the final shape appearing do not depend on piezo and take months, depending on skin type.
Does using piezo affect the cost?
Using the device can affect the cost. The quote is based on the scope of the operation and is given in writing after the consultation.
Related treatments
Articles on this topic
Sources
- Kisel J, Khatib M, Cavale N. A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review. Aesthetic Plastic Surgery, 2023.
- Ishii LE et al. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology–Head and Neck Surgery, 2017.
The information on this page is for general guidance only; diagnosis and treatment decisions are made by the doctor after a consultation. Results of surgical and interventional procedures vary from person to person.