Is ultrasonic rhinoplasty applicable to ethnic cases?

Question

Dear sir/madam, I would be interested to find out how ultrasonic rhinoplasty is applicable to ethnic cases, e.g. Asian, when there is elevation/reconstruction that is required, and not just drilling/reducing the bones? Can you please help shed more light on this - e.g. perhaps it's useful for carving rib cartilage and etc? Best

Lucian Ion, FRCS · Answer

Ultrasonic instrumentation used in rhinoplasty  is a technical opportunity  through its precision and with it the ability to produce more  accurate shape changes.Like any tool,  it depends how it is used in order to achieve results.  Although it can indeed be used for carving rib cartilage,  there are very few instances when this may be superior to normal cartilage reshaping with sharp  instruments.There are situations when the rib cartilage is calcified,  and ultrasonic instrumentation can make all the difference. Otherwise,  the differences in procedures that you are referring to are mostly driven by the characteristics of the planning rather than technical differences in execution.

Jag Chana, MD, FRCS(Plast) · Answer

Ethnic rhinoplasty is a very diverse term and so it depends what is required. The real advantage of ultrasonic rhinoplasty is in the bone reshaping. If the ethnic rhinoplasty requires a dorsal augmentation with rib grafts then the ultrasonic procedure is less useful although some surgeons have used the device for rib graft harvest but in my opinion there is no real advantage unless the rib cartilage is very dense and ossified. If the ethnic rhinoplasty is mainly for soft tissues and for example tip refinement / alar base reduction then this technique has no advantage. If the nasal bones need reduction or narrowing then yes it is useful. Many surgeons will achieve great results with standard techniques but since ultrasonic rhinoplasty is new it means very few have the experience of using the new tool. My experience is that it is very useful since it does allows very precise bone sculpting. The bone reshaping and sculpting ability provides more versatility during surgery. Furthermore there is no collateral damage to soft tissues since the ultrasonic energy is tuned to the bone itself and does not affect the surrounding tissues. This means faster recovery times with little or no bruising in the early phase of healing. In ethnic rhinoplasty the advantage here is the fact that heavy bruising under the eyes can cause staining and pigmentation for a few months. This can be avoided with ultrasonic techniqes. If you see in the video below  of a patient who wanted her nose simply straightened and a dorsal reduction - when the cast comes off there is no bruising a 7 days !
Also the fact that a hammer and chisel technique is avoided there is more control thereby avoiding unwanted fractures and splintering of the bone. This is useful in controlling the bone reshaping very precisely and reduces the revision rate for bony irregularities.

Santdeep Paun, MBBS, FRCS · Answer

Ultrasonic rhinoplasty is merely using a specific instrument (Piezo) to assist with the surgery. It is only a tool and ultimately the surgery itself can be done in many different but equally effective ways. Piezo can be used in a variety of ways - to shave bone, break bone, drill bone and even to shape and harvest cartilage at times. Even in Asian rhinoplasty some of these steps may be performed but normally, as you mention, the aim in Asian rhinoplasty it to add structure rather than reduce it. Piezo is not particularly helpful in my mind with carving rib etc. 
I think the term ultrasonic rhinoplasty is misleading as the Piezo is only used for certain aspects of the operation. Again - to reiterate it is only an instrument like many others we use during surgery. Ultimately it is the surgeon who will decide the best way of doing the various steps in the op based on their experience. Carving cartilage for instance is an art that can take years to develop!
It is much more important to ensure your surgeon is skilled in performing Asian rhinoplasty rather than worrying about what instruments they may use!

David Kahng, MD · Answer

hi
using ultrasonic technology is just another tool in the surgeon's bag to perform Asian rhinoplasty surgery but it only applies to doing bone work to cause less swelling and bruising.  it is great tool to have when doing osteotomies to narrow the width of the bony nose bridge.  as for carving ribs.....doesn't help.  hope this helps.

dr david kahng

Is ultrasonic rhinoplasty applicable to ethnic cases?

Answers (4)

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