Piezo surgery in open rhinoplasty: precision, preservation and progress

In recent years, the core philosophy of rhinoplasty has evolved from destructive resection to less invasive preservation techniques. Despite this shift, open rhinoplasty retains its relevance by enabling precise visualisation and modification of nasal structures via the transcolumellar approach. However, with its reliance on larger incisions and associated soft tissue trauma the method is not compatible with the principles of minimally invasive surgery.

An innovative enhancement to this technique is therefore piezo surgery, which employs ultrasoundpowered instruments for precise bone cutting and sculpting with maximum protection of the surrounding soft tissue. Particularly in osteotomy – a central step in open rhinoplasty – piezo surgery offers controlled incision guidance that avoids irregular bone fractures, which often occur with traditional instruments such as hammer and chisel. In this context, Goksel et al. (2019) emphasise that piezoelectric instruments enable safe and precise handling in lateral and transverse osteotomies while minimising trauma to the surrounding tissue.

By precisely controlling the depth and direction of the incision, piezo surgery enables accurate reshaping and enhances aesthetic results while reducing post-operative complications such as edema, ecchymosis and irregular bone margins. These advantages make piezo surgery a significant advance in rhinoplasty, especially for complex and reconstructive procedures. In contrast to conventional methods, in which bone is often removed, piezo surgery allows for conservative dorsal hump reduction while preserving the osseous framework. This is particularly important in structure-preserving rhinoplasty, where the natural anatomy, including the dorsal aesthetic lines and ligamentous structures, should be widely preserved.

Piezo surgery is already showing promising results in open rhinoplasty and holds significant potential to refine current surgical protocols. Additional studies will further substantiate the long-term benefits and broad applicability of this method.

W&H advances this field with a state-of-the-art piezo surgery module and specialised instrumentation, empowering surgeons to leverage the full potential of piezo technology in rhinoplasty and further optimise precision and safety during demanding procedures. Even though open rhinoplasty provides unparalleled anatomical access, the closed approach utilises intranasal incisions to eliminate visible scarring – a critical consideration in aesthetic surgery. The next report will therefore examine the use of piezo surgery in closed rhinoplasty and the associated possibilities in modern surgery.

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