Piezo ultrasound technology for Rhinoplasty. Why is this not as embraced in the US?

Question

I have noticed that piezo ultrasound technology is being used more and more outside the USA for rhinoplasty. There are less than a handful of plastic surgeons using this technology in the USA. The results from piezo appear to be far superior and more precise than the traditional method of using a hammer and chisel. Seems it would be a great tool in the toolbox of the surgeons. Why are doctors in the USA seemingly reluctant to embrace this new bone cutting technology for rhinoplasty?

Christian L. Stallworth, MD · Answer

Like any technology, there can be those that are slow to adopt because in their eyes for whatever reason it is not been completely proven yet. I will say that there are far more than a handful of surgeons that are using Piezo in the United States. But like everything else there are pros and cons to using it versus traditional osteotomes.This technology is very expensive. In order to utilize it you have to have a hospital or surgery center that is willing to spend the tens of thousands of dollars to buy the equipment. Then once you have it there are the costs of the individual blades and handpieces for each patient.  These together increase the cost considerably.And then there is the issue of the dissection. It requires considerably more elevation of the soft tissue envelope on the nose beyond what would be done traditionally. The more elevation equals the more scar tissue and the more bleeding, etc., and it will always be difficult to have a surgeon that has been doing something reliably for 20 to 30 years to change to adopt something that they are less familiar with or trustworthy of.Thirdly, the recommendations from around the world currently are to stop using Piezo in rhinoplasty for the time being. It causes a considerable amount of aerosolized mist during the case and in the COVID-19 environment this can be deadly for a surgeon or operating room staff that are exposed if a patient is positive for the virus.In the end, this is a fantastic technology, lots of people are using it, but it is not a hammer that fits every nail. If you are interested in rhinoplasty, please focus on the results you desire and find a surgeon that you trust that can give you those results rather than the means by which they used to get there.Hope this helps.Best wishes.

Nima Shemirani, MD · Answer

Hi @thomas's! I use Piezosurgery in my practice and I absolutely love it! This technology is very expensive.  Piezosurgery is a more gentle technique that allows for greater precision. Less bruising and swelling is common with Piezosurgery. In a typical rhinoplasty, a hammer and chisel technique is performed leading to more inadvertent fractures. I hope this was helpful!

Colin Pero, MD, FACS · Answer

Sorry for the misleading title, but this reminds me of when a patient asks if we can use a laser instead of some other tool.  Sometimes that is a good idea, sometimes it is not.  Similarly, piezo is a tool to make cuts in the bone during rhinopolasty.  Traditional techniques using sharp osteotomes to make the cuts are another technique.  In experienced hands, both should produce good outcomes, although there are some nasal deformities that do not do as well with piezo.  I agree that results are what matters and the means to get there should be decided upon by the surgeon.  That said, by all means, question your doctor and make sure you are comfortable with their answers/approach.  Best of luck.

Thomas Trevisani, MD · Answer

I agree with Dr. Stallworth. And I would also add that I have tried this method and strongly believe that sharp osteotomes and experience by the Surgeon will produce far more precise bone position changes without the enormous added trauma caused  this traumatic method. The marketing of this product benefits the company more than the patient.

Behrad Elmiyeh, MBBS, MRCS, FRCS (ORL HNS) · Answer

This is an excellent question. 
  
Piezo ultrasonic is only one instrument in a surgeon's armaments. Piezo like any instruments has its own pros and cons. Since it is a relatively newer instruments many use this as a marketing tool.
  
Rhinoplasty frequently requires reshaping and repositioning the nasal bones, traditionally osteotomes are used to break bones. Piezo uses ultrasonic vibration to make the cut in the bone. 
  
Any instrument is only as good as the hands of the surgeon using it. Ultimately it is paramount to focus on the outcome of a rhinoplasty surgery than the instruments used.
  
When a surgeon gets great results using sharp osteotomes changing instruments may even produce less than desired outcome.
  
Best wishes,

Piezo ultrasound technology for Rhinoplasty. Why is this not as embraced in the US?

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Piezo ultrasound technology for Rhinoplasty. Why is this not as embraced in the US?

Answers (5)

Answer: Piezo ultrasound technology for Rhinoplasty

Answer: Piezo ultrasound technology for Rhinoplasty

Answer: Rhinoplasty

Answer: Rhinoplasty

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Everything you need to know about Rhinoplasty

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