I read some surgeons use ultrasonic Pienzo technique what are the pros and cons with it?

The Pienzo method of rhinoplasty is relatively recent. Supposedly you would have less bruising but the thing that matters must is the final result. Concentrate on finding an experienced rhinoplasty surgeon regardless of which technique is used.

Hi @Dinina. This is an excellent question. 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. Piezosurgery can also be utilized with a closed rhinoplasty. Best of Luck, Dr. Nima!

The ultrasonic tools produce a more precise cutting effect for the bone, in many ways similar to what you would expect from using a micro-saw. Using osteotomes produces a splitting effect for the nasal bones which provides less control and is more operator dependent.

In terms of osteoplasty, effectively shaving down or sculpting the nasal bones, the process is considerably more accurate with ultrasonic tools in particular on the sidewalls.

Treatment of asymmetry and deviations often requires differential treatment for the nasal bones and more complex management of the septum which can benefit from the precision of ultrasonic instruments.

As the ultrasonic instruments require visualisation, undermining of the nasal bones is more extensive compared to manual instrumentation. For reasons that are not entirely clear, bruising is uncommon with ultrasonic instruments but swelling of the nasal bridge can be longer lasting than with manual instruments which do not require the same amount of undermining.

Although the ultrasonic instrumentation can be used for close interventions it is not well adapted to this purpose. The risk of damage to the soft tissues (burns) may be higher when the system is used in a tight space.

Around the world, surgeons are achieving good results with both techniques, but by and large the surgeons that adopt ultrasonic instrumentation do not seem to be keen to go back to manual instruments. This is perhaps the most significant endorsement of the technique.