Are the terms preservation & ultrasonic rhinoplasty just marketing buzzwords?

Question

I see many surgeons advertising these approaches. My question is are there any actual advantages to using ultrasonic tools? And isn't every rhinoplasty a preservation one since the goal is to preserve the nose as much as possible?

Lucian Ion, FRCS · Answer

Thank you for your question. I cannot answer much about preservation rhinoplasty since it is not a technique I use.

I have been using ultrasonic tools for rhinoplasty for the last eight years and I can say that they have completely transformed the way I carry out surgery since they offer a number of differences compared to manual instruments and I would never consider going back to manual instruments:
- accuracy of the cuts through the nasal bone, which allow more predictable reconfiguration of the nasal bridge
- options for improvement of the alignment of the nose in high septal deviations without widening the bridge and without risk of CSF rhinorrhoea
- smoother the contours of the nasal bones
- ability to use small grafts of ethmoid bone to strengthen the cartridge framework in key areas
- ability to harvest and use the calcified rib cartilage graft witch is otherwise an almost impossible task
- ability to contour the nasal spine with precision
- ability to do multiple level osteotomies for severe deformities of the nasal bones typically related to major trauma

The concept of preservation rhinoplasty is related predominantly to maintaining the contours of the nasal bridge cartilages when they are producing a good nasal shape. Some of these characteristics can also be achieved through hybrid bridge reduction techniques favoured by ultrasonic instrumentation.

Oakley Smith, MD, FRCSC · Answer

Preservation rhinoplasty is a surgical technique that focuses on maintaining the natural structure and function of the nose, while improving its appearance. Unlike traditional rhinoplasty, which often involves removing or significantly altering the underlying cartilage and bone. The use of ultrasonic or piezoelectric instruments in surgery adds more precession in the surgical procedure, and help avoid unwanted fracture line during the step of reshaping the nasal bones

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.For rhinoplasty surgery there are many different techniques. But the most important thing is to perform the surgery in the most appropriate way to the patient. So I recommend you to ask your surgeon (if you already have one) which approach would be the best for you!

Anil R. Shah, MD · Answer

Great question!!  So as far as ultrasonic rhinoplasty goes, it is a specific instrument used to reshape the nose using soundwaves versus using a chisel.  When used properly, the whole nasal platform is seen, making the nose much less guess work and more predictable than using a handheld rasp.  Keep in mind, the instrument does not mean the result will be better or worse, but just a tool in a surgeon's hand.  The surgeon is the key element here.

For preservation rhinoplasty, this is a generic term which can mean preserving any part of the nose.  More likely, the surgeon is probably discussing dorsal preservation rhinoplasty where the drop the bridge down.  This was formerly called drop-down and let-down rhinoplasty but for obvious reasons did not succeed as marketing terminology.  Again, the big point here is to chose your surgeon rather than technique based on before and afters, etc.

Good luck!!!

Eric M. Joseph, MD · Answer

To the best of my understanding, preservation rhinoplasty involves preserving the nasal bridge during hump removal. For example, if someone has a hump on profile, hump reduction utilizing preservation techniques involves removing bone in between the top of the bridge and the bottom. After 24 years of performing rhinoplasty, we have found no need to modify our technique for removing a dorsal hump.

Ultrasound is used by some surgeons when performing osteotomies. This is also a relatively new technique which we do not use. Great questions! Doctor Joseph

Ultrasound is used by some surgeons when performing osteotomies. This is also a relatively new technique which we do not use. Great questions! Doctor Joseph

Ronald J. Edelson, MD · Answer

Results of rhinoplasty are dependent on the skill of the surgeon regardless of any fancy tools or terms they use. Don’t let these other things draw your attention away from the most important thing, selection of the right surgeon. These other things are merely a distraction

Zoran Potparic, MD · Answer

This is relatively new technique in Canada/US, known for 10-12 years in Europe. Goal is to reduce disection of dorsum of the nose to remove small humps; correction is done by removing portion(s) of septum cartilage. Osteotomies are done  (now using US device) to push nose inside and reduce the nose hight. This may have some adventage regarding postoperative swelling/recovery in comparison to a traditional rhinoplasty? You should check a surgeon and his experience with this technique to avoid being one of the first patients. Good luck.

James C. Marotta, MD · Answer

I perform both dorsal preservation rhinoplasty using ultrasonic instruments and open structure rhinoplasty using standard rhinoplasty tools.   As in any technique, the devil is in the details. One is not inherently better than the other.   I am very careful in patient selection.   Dorsal "preservation"  can be as disruptive or more than standard techniques given you fracture the entire nasal complex and remove some of the dorsal supports to bring a hump down.  The only thing preserved in some cases is the junction between the upper laterals and the dorsal septum.   The key is the surgeon skill at performing rhinoplasty, their experience with any technique they are using, and appropriate patient selection.    For example, a surgeon advertising ultrasonic rhinoplasty and dorsal preservation may be doing his 3rd case (given this technique is relatively new to most surgeons).    I hope this information helps.

Jeffrey H. Spiegel, MD · Answer

Preservation rhinoplasty is a new technique where the top of the nose is brought down from inside instead of the top.  Ultrasonic rhinoplasty means the surgeon uses an ultrasonic bone aspirator instead of a rasp.
For ultrasonic - it doesn't really make much of a difference.  The best outcome is what the surgeon is used to. The same goes for preservation rhinoplasty. It's just another means to an end, but, the outcome should be good with any method with which the surgeon is familiar.  In general, preservation rhinoplasty is a newer technique so the surgeon will have had much less experience doing it.

Thomas Spalla, MD · Answer

Your surgeon's experience and knowledge are the best tools. Following their recommendations pre- and post-operatively will help you get the best result they can achieve.

Ultrasonic rhinoplasty is a newer way of making incisions in the nasal bones. Some purport that it's more controlled, or precise, but again, your surgeon's experience will give you the safest and most predictable result. If they aren't comfortable with such a device, they shouldn't be using it despite what the ultrasonic companies may have you believe with their marketing materials saying it's the "best" thing for you.

Preservation rhinoplasty (I think this is what you're asking) is probably referring to "dorsal preservation rhinoplasty, which is a technique that aims to lower the nasal dorsum through modifications to the nasal bones and septum below the dorsum and infracture the dorsum downwards rather than the usual technique of removing and smoothing the dorsum.