Ultrasonic Piezosurgery in Rhinoplasty

Piezoelectric (Ultrasonic) Surgery

During aesthetic nose operations, the bony nasal framework constituting the ½ upper part of the nose should be reduced or re-shaped by making incision, for reducing big noses, narrowing wide noses and correcting crooked noses

The mechanical hand tools such as hammers, chisels, and rasps that have been used with intent to reshape the nasal bones ever since the initial periods of rhinoplasty practices are still commonly used; however, recently motorized devices that make it possible to cut and re-shape the bones more precisely have begun to be used, as well.

 Motorized devices have certain advantages over the mechanical tools in terms of surgical precision; but on the other hand, they also have some disadvantages like tissue damages caused by overheating of the bone and soft tissue damages due to surgeon's desensitized sense of touch and the difficulties in determining the depth of incisions.

Piezoelectric devices which can make incisions in the bony tissues through ultrasonic vibrations, by operating based on the piezoelectric principles, had first started to be used in the field of maxillofacial surgery after year 2001, have recently begun to be successfully used also in  rhinoplasty operations  .

The most important feature of this technology coming to the fore is that a cutting effect is created on mineralized hard tissues such as bone, through ultrasonic vibrations while causing no damage to nearby soft tissues such as mucosa, blood vessels, and nerves.

During the operation of piezoelectric devices consisting of a main unit, hand tool, and active cutting edges, the functioning active cutting edges exhibit longitudinal vibrations ranging from 40 to 200 µm, and vertical vibration ranging from 20 to 60 µm, and such devices require lower pressure on the bone for obtaining the cutting effect, compared with that required by mechanical devices used for the same purposes.

The major advantages obtained by using piezoelectric devices in   rhinoplasty operations  are :

• No bleeding in the neighboring tissues and no related postoperative bruises around the eyes are observed because of the fact that no damage occur in the adjacent mucosa and the vascular tissues thanks to precision incisions made in exactly the desired points of the nasal bones.

• Bone healing is 60% faster compared with standard mechanical techniques.

• Soft and smooth nasal bone features can be achieved more easily.

Despite these very special advantages provided by piezoelectric surgery during rhinoplasty, the most important factors that ensure the operation to result in success functionally and aesthetically are surgical techniques applied to the cartilage part that constitutes ½ of the front part of the nose, where is the narrowest portion of the air passage and the surgeon ’ s knowledge about rhinoplasty, as well as his/her conception of aesthetics and experience.