Minimally invasive with maximum precision: Piezo surgery for closed rhinoplasty

Functional-aesthetic rhinoplasty can be performed using either an open or closed (endonasal) approach. While many surgeons prefer open rhinoplasty as this provides improved visibility of the anatomical structures involved, it is not necessary in every case. For patients with thin skin, moderate dorsal deformities or less complex nasal tip deformities, closed rhinoplasty offers clear benefits: with intranasal approach, there is no external scarring and the soft tissue integrity is largely preserved. This contributes to an aesthetically pleasing result and supports fast healing by retaining the natural tissue architecture.

^{Closed approach septorhinoplasty by Dr. Philipp Mayr.}

These benefits, however, require a high level of surgical precision, as the restricted visibility and limited access make modelling of the bony structures more challenging. Piezo technology enables significant progress to be made here, as demonstrated by a recent study by Guilarte and Malzone (2025). The study shows that the use of piezo surgery in closed rhinoplasty enables osteotomies and resections to be performed with millimetre precision and minimal tissue trauma. Among 734 patients, the revision rate stood at just 6%, with most of these revisions traceable to minimal irregularities of the dorsum. Although the closed technique has primarily been used for simple deformities until now, the study indicates that it can also be applied in more complex cases with high precision when combined with piezo surgery.
Of particular note is the ‘let-down technique’, which enables minimally invasive correction of dorsal deformities such as S-shaped nasal bones, without subjecting the surrounding soft tissue to unnecessary trauma.

Currently, piezo technology in closed rhinoplasty is primarily used to treat the nasal dorsum, and perform lateral osteotomies, as well as transversal and radix osteotomies. In order to improve precise handling when working with limited visibility, surgical techniques and instruments alike are constantly being enhanced and refined. Surgical adjustments, such as extended subperichondrial dissection and targeted incision modifications, provide improved exposure of bony structures. Optimised cooling systems and the instruments’ water supply also minimise the risk of skin and bone damage. These advancements enable more precise, tissue sparing modelling, and contribute to the safety and efficacy of the closed rhinoplasty approach.

The study from Guilarte et al. (2025) highlights the potential of piezo surgery to transform closed rhinoplasty from a ‘blind’ procedure into a precision-controlled, reproducible technique with predictable results. The findings also indicate a clear need for longer and more precise instruments that meet the specific requirements of closed rhinoplasty and optimise the manoeuvrability despite limited access.

W&H addresses these needs with extended piezo instruments that are specially optimised for intranasal access. Developed in collaboration with surgeons, these instruments are designed to enable precise resections even in hard-to-access areas, thereby helping to take closed rhinoplasty to the next level.

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