Piezo or normal osteotomy?

The Piezo Device allows ultrasonic bone shaping. After 25 years of performing rhinoplasty surgeries, we have no desire to try this instrumentation. There are reusable's that are costly, and this would be reflected in your fee for rhinoplasty. Additionally, there is no data to support the regular use of this technology for rhinoplasty surgery. I understand that some surgeons advocate it, however, I believe that most of us do just fine without it. Thank you for this excellent question. Sincerely, Dr. Joseph

Piezo is just a tool. It is slower and doesn't provide any significant improvement over using a tried and true method of rasps or osteotomes. You may possible have slightly less bruising with Piezo, but that resolves quickly.

Hello and thank you for your question. I have colleagues performing both Piezo and traditional osteotomies who have great results. I think callus formation and other complications possibly associated with the Piezo technique like crepitus (air under the skin creating a crackling sound) are often surgeon-dependent. I think the key next step for you is to find the right aesthetic plastic surgeon to discuss this further.

In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course. Also, be sure to see plenty of before-and-after pictures in patients who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon. It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Hello and thank you for your question. In my experience, there is not much difference between the two techniques. I would not decide your surgeon based on this, but rather based on your surgeon’s overall body of work. Here is some general advice on selecting a good surgeon. I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results.

I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for your question. I have used both techniques. I find them almost interchangeable. I tend to use the piezoelectric for a more complete osteotomy on my preservation cases and an external noncontinuous traditional osteotomy on my open structural cases. Both work well and have very little consequences. I hope it helps. Best wishes to you.

Piezo is a gimmick and offers no additional advantages than osteotome. Choose your rhinoplasty specialist very wisely based on extensive experience. Look at their before and after photo gallery, which should be reflective of their practice.

I recommend against the temptation of selecting providers based on some brand name, technology or device. No device is going to make the difference of a quality out, versus results leading to frustration and need for further surgery.
Equipment usually has very little to do with the overall experience and aesthetic outcome.
The actual choice of provider combined with the patient’s candidacy for the procedure are the two variables that matter, and I suggest patients focus all the efforts on first understanding their candidacy, and secondly finding the best provider regardless of what instruments they use.
Find the plastic surgeon is difficult enough without adding variables like trying to understand the importance of branded equipment.
Mastering rhinoplasty surgery is difficult and takes decades.
Typically finding the right provider requires having multiple in person consultations. At which time you should ask providers to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own.
Look for plastic surgeons member of the rhinoplasty society.
Best,
Mats Hagstrom MD