Ultrasonic Rhinoplasty: Less Swelling, More Precision

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What is ultrasonic / piezo rhinoplasty?

Ultrasonic rhinoplasty, also known as piezo rhinoplasty, is an advanced surgical technique that uses high-frequency ultrasonic vibrations instead of traditional cutting instruments (osteotome, hammer, chisel) to shape the nasal bones and cartilage. The name 'Piezo' comes from the piezoelectric energy it uses.

How does ultrasonic rhinoplasty work?

The working principle of this cutting-edge method in rhinoplasty surgery is as follows: A special scalpel at the tip of the piezo device vibrates at frequencies too high for the human ear to hear. These vibrations create an energy that can only recognize bone tissue and cut it selectively. The vibrations cut hard tissues (bone) by breaking them down at a microscopic level. Soft tissues (nerves, blood vessels, cartilage, mucosa) are almost unaffected and preserved.

Pros and cons of the ultrasonic technique

Pros:

Superior precision and control

Millimetric cutting:

The piezo device allows the surgeon to make millimetric cuts on the bone. It prevents unwanted, uncontrolled small fractures that can occur with the traditional hammer and chisel method.

Selective cutting:

It targets only bone tissue; it causes almost no damage to nerves, vessels, and soft tissue. This allows the surgeon to work much more safely and with greater control.

Minimisation of tissue trauma

Soft tissue preservation:

In the traditional method, hammer blows fracture the bone, causing the surrounding soft tissues to shake and become damaged. With Piezo, this physical trauma is almost negligible.

Less internal bleeding:

As soft tissue and blood vessels are preserved, bleeding during surgery is significantly reduced.

Less bruising and swelling

Low risk of bruising around the eyes:

Bruising around the eyes, one of the most prominent side effects of traditional rhinoplasty, is greatly reduced or completely eliminated with Piezo. The main reason for this is that the fine blood vessels around the nose are not damaged during the bone reduction process.

Less swelling:

As tissue trauma is minimal, the body's inflammatory response (swelling) is also minimal.

Fast and comfortable recovery process

Quick return to social life:

Less bruising and swelling allow the patient to return to their normal social life and even work much sooner. Many patients report that this process is much more comfortable than they had anticipated.

Less pain:

Since there is minimal trauma to the nerve tissue, postoperative pain complaints are significantly reduced compared to the traditional method.

Excellent results:

Smooth bone surface:

With piezo, the bone surface can be shaved more smoothly and evenly. This contributes to achieving a more natural and smooth contour (line) on the nose after surgery.

Superiority in complex and delicate work:

It is extremely successful, especially in patients with a thin and fragile bone structure, in reducing the small nasal bridge or correcting asymmetry.

Safety in revision surgery:

It is a much safer option than traditional methods in patients who have previously undergone surgery and whose bone structure has weakened.

Cons:

High cost

Piezo rhinoplasty is significantly more expensive than traditional methods. The main reason for this is the high cost of the disposable piezoelectric tips used.

Surgeon experience

This technique requires a different level of manual dexterity and experience than the surgeon's reflexes in traditional methods. The surgeon must undergo special training and practice in order to use the technique correctly and effectively.

Limitations with bone procedures

The piezo technique is primarily designed for working on bone. Traditional surgical instruments (scalpel, scissors) are still required for procedures such as shaping the nasal tip cartilages, narrowing them, or preparing grafts (cartilage pieces) for support.

Piezo replaces these instruments in bone procedures, but when considering the entire operation, it is generally applied as a combined technique. In other words, the surgeon can use both Piezo and some traditional methods in the same operation.

Increased procedure time

Bones that can be broken with a few blows using the traditional method may take slightly longer to process with Piezo, as they are shaved more slowly and in a controlled manner. However, this is a minor detail that does not significantly affect the overall duration of the operation.

Ultrasonic/ piezo rhinoplasty vs traditional rhinoplasty: Comparing ultrasonic and traditional methods.

Ultrasonic/piezo rhinoplasty vs. traditional rhinoplasty: A detailed comparison

Who is the best candidate for ultrasonic rhinoplasty?

Ultrasonic rhinoplasty may not be suitable for every patient. Patients with specific characteristics and needs benefit most from the advantages offered by this technique. The best candidates are:

Those with a bony and wide nose structure

Nasal hump:

It is ideal for individuals with a prominent hump (bump) on their nose caused by bone. Piezo creates an extremely natural contour by smoothly shaving this bone.

Wide nasal bridge:

The Piezo technique is particularly advantageous for narrowing a wide nasal structure (osteotomy) where there is excessive space between the nasal bones. The bones are narrowed in a controlled manner, preventing unwanted fractures.

Those with thin and fragile nasal bones

These are individuals with a thin and delicate bone structure, commonly seen in female patients. In the traditional method, hammer blows can cause collapse or irregular fractures in these thin bones. Piezo's precise vibrations, however, shape the bone without fracturing it, significantly eliminating this risk.

Those prioritising the healing process and comfort

• Piezo is the best choice for patients who want to experience as little bruising and swelling as possible after surgery.
• Those who need to return to their social life, work, or school quickly (e.g., students, employees) experience a much more comfortable recovery period with this technique. As bruising is largely prevented, they do not have to worry about concealing the surgery.

Individuals who have previously undergone surgery for aesthetic purposes (revision rhinoplasty)

Revision surgeries are more challenging because the nasal structure has already undergone trauma once. The bones are thinner and more fragile.

Piezo enables the surgeon to achieve maximum control in such complex cases, allowing safe shaping without damaging the existing structure.

Those with nasal asymmetry

These are individuals with curvature or irregularities in the bone structure of the nose. Piezo's millimetric precision allows the surgeon to shape the bones evenly and symmetrically to correct the asymmetry.

Those with high aesthetic expectations who value detail

It is ideal for perfectionist patients who want not only functional correction of the nose but also a natural, smooth, and flawless appearance. With Piezo, the bone surface is smoother and does not give the impression of having undergone surgery.

What is closed ultrasonic rhinoplasty?

Closed ultrasonic rhinoplasty is a surgical technique that combines two key advantages in nose reshaping procedures. That is, this method combines the advantages of 'discretion' (leaving no external traces) and 'precision' (avoiding tissue damage) in the same operation.:

Closed approach: A surgical approach in which the surgeon performs all incisions and procedures through the nostrils, leaving no external incision marks on the skin.

Ultrasonic technology (piezo): An advanced technology that uses high-frequency ultrasonic vibrations instead of traditional hammers and chisels to shape bones.

The working principle is as follows:

• The surgeon performs all the necessary work to shape the nose through small incisions made inside the nostrils. These incisions are invisible when viewed from the outside. For this reason, it is also known as 'scarless rhinoplasty.'
• The surgeon inserts the fine, specialized tips of the piezo device through these small incisions. These tips vibrate at a high frequency, selectively cutting and shaving only the bone tissue. The surrounding soft tissue, blood vessels, and nerves are preserved.
• Procedures such as bone reduction (hump reduction), bone narrowing (osteotomy), and smoothing bone irregularities are performed with this precise instrument.
• Procedures such as shaping the nasal tip cartilages are still performed using traditional surgical instruments, adhering to the principles of the closed technique.

What is open ultrasonic rhinoplasty?

Open ultrasonic rhinoplasty is a combination of two techniques used in nose reshaping surgery. In other words, this method combines the advantages of 'maximum visibility and control' (open technique) with 'maximum precision and tissue preservation' (ultrasonic technology).

Open approach: A surgical approach in which the surgeon makes a small incision on the thin band of tissue called the columella in the midline of the nose to provide direct view and access to the nasal structures.

Ultrasonic technology (piezo): Advanced technology that uses high-frequency ultrasonic vibrations instead of traditional hammers and chisels to shape bones.

The working principle is as follows:

• First, the surgeon makes the necessary incisions inside the nostrils.
• Then, a small incision in the shape of an inverted V (or similar) is made in the area called the columella, just below the tip of the nose. These incisions allow the skin of the nose to be lifted upwards, exposing the nasal skeleton (bone and cartilage) completely to the surgeon's view and intervention.
• Once the nasal structures are fully visible in detail, the surgeon begins to use the Piezo device. Piezo's special tips work with millimetric precision on the bone. Procedures such as bone reduction (hump reduction), bone narrowing (osteotomy), and smoothing bone irregularities are performed here.
• While performing these procedures, the Piezo targets only the bone tissue. The overlying skin, mucosa, nerves, and vascular tissues are almost completely spared.
• The open technique provides an ideal environment for shaping the cartilages at the tip of the nose, correcting asymmetries, and placing grafts (supporting tissue). The surgeon performs all these procedures with direct visualization.
• Once all shaping procedures are complete, the nasal skin is repositioned and the incisions are closed with aesthetic sutures. The incision in the columella typically leaves a minimal scar that is barely noticeable once healed.

Piezo rhinoplasty procedures

Piezo rhinoplasty follows the general stages of a rhinoplasty procedure, except that it uses a more precise bone-shaping technique compared to traditional methods. However, the difference in bone procedures positively affects the entire process.

Pre-operative preparation and planning

Your surgeon will assess the structure of your nose (skin thickness, cartilage, and bone condition), your respiratory function, and your aesthetic expectations.

It is determined whether the piezo technique is suitable for you (cases requiring bone work are generally ideal candidates).

The risks, advantages, and expected results of the surgery are discussed in detail.

Photographs of your nose are taken from different angles.

In some clinics, digital simulations are performed on these photographs, the possible results are discussed with the patient, and a surgical plan is created..

Blood tests and other necessary examinations will be performed to check your general health.

Smoking, alcohol consumption, and the use of blood-thinning medications (aspirin, ibuprofen, etc.) should be discontinued for a certain period of time prior to surgery.

The day of surgery and the surgical procedure

Anesthesia:

The surgery is performed under general anesthesia and lasts an average of 2-4 hours.

The patient is put to sleep under general anesthesia and feels no pain or discomfort. The inside and surrounding area of the nose are sterilized.

Surgical approach (open or closed technique)

Open Piezo rhinoplasty: The surgeon makes a small incision on the thin band of tissue called the columella at the tip of the nose and lifts the nasal skin to directly view the entire nasal structure. This allows for greater control in complex cases.

Closed Piezo rhinoplasty: All incisions are made inside the nostrils. There are no external scars, but the surgeon's working area and visibility are more limited.

Bone procedures

This is the critical stage that makes Piezo rhinoplasty unique:

The surgeon inserts the Piezo device's fine, specialized tip through the nostrils or into the area created using the open technique.

The device operates by emitting high-frequency ultrasonic vibrations. These vibrations target only the hard bone tissue, cutting it at the micron level.

The bone and cartilage arch on the bridge of the nose is shaved precisely with the Piezo tip to create a smooth line. The underlying cartilage structure remains undamaged.

To narrow wide nasal bones, controlled cuts are made on the sides of the bones using the Piezo. They are not broken with a hammer as in the traditional method. This protects the surrounding tissues, blood vessels, and nerves, minimizing bruising and swelling.

Cartilage procedures

Piezo is not generally used for cartilage procedures. Shaping, thinning, or reinforcing the tip cartilages with support grafts (usually cartilage pieces taken from inside the nose or ear) is performed using traditional surgical instruments (scalpel, scissors).

Closure

• Once all shaping procedures are complete, the surgeon reattaches the nasal skin and closes the incisions with aesthetic sutures.
• To preserve the new shape of the nose and control swelling, a tampon (silicone or loose tampons) is placed inside the nose, and a plaster cast or splint is applied to the outside of the nose.

What are the risks of an ultrasonic rhinoplasty procedure?

Although piezo technology reduces many risks, it can give rise to certain specific situations:

As the piezo device operates using ultrasonic vibrations, it generates heat. If the surgeon does not cool the area adequately (saline irrigation) or remains in one spot for too long, this heat can cause damage to the surrounding soft tissue, cartilage, or bone. This risk is extremely low when performed by a skilled, experienced surgeon.

Piezo rhinoplasty requires a different level of manual dexterity and experience compared to traditional methods. A surgeon who has not received sufficient training and gained experience in this area may not be able to utilize all the advantages of the technology. This can lead to problems such as uneven bone surfaces, undesirable aesthetic results, or prolonged surgery duration.

Piezo is extremely effective on thin and medium-thickness bones. However, in unusually thick and dense bone structures, the procedure may take slightly longer compared to traditional methods.

Although there is no medical risk, piezo rhinoplasty is more expensive than traditional methods. It represents a significant financial investment for the patient and may be considered a 'risk' or practical disadvantage.

Healing / aftercare of ultrasonic rhinoplasty

Although ultrasonic rhinoplasty provides a more comfortable and faster recovery than traditional methods, it is very important to strictly adhere to the postoperative care rules for the best possible outcome. The healing process develops as follows:

The first 24-72 hours after surgery

During this period, maximum rest and care are required.

There will be swelling, but bruising may be minimal or absent thanks to Piezo technology.

You may experience pressure, a feeling of fullness, or headaches. Pain is generally mild and can be managed with the painkillers provided.

Your nose may feel blocked due to internal swelling and the presence of tampons.

A slight bloody or clear discharge from the nose is normal.

Always keep your head elevated at a 45-degree angle, even while sleeping. Use several pillows or lie down on a chair. This significantly reduces swelling.

Place a cold gel pack or cloth wrapped in a thin towel on your cheeks and around your eyes (on your nose and without pressing on the cast). For the first 48 hours, apply for 15-20 minutes, then take a 15-20 minute break.

Avoid strenuous activities at all costs. Rest as much as possible. Be careful not to bend over or lift heavy objects.

Take all prescribed medications (antibiotics, painkillers) regularly as instructed. Do not take any medication containing aspirin or ibuprofen without your surgeon's approval, as these may increase bleeding.

Eat soft, cold, and easily digestible foods. Drink plenty of water. Avoid hot drinks and spicy foods for the first few days.

First week

Swelling and bruising peak on days 2-3 and then begin to subside.

You will have a plaster cast or splint on your nose.

First check-up (usually days 5-7)

Your surgeon will remove the plaster cast/splint from your nose and any internal packing or stitches.

You will see your new nose shape for the first time, but it will be quite swollen.

Continue to keep your head elevated at a 45-degree angle at all times, even while sleeping.

Your surgeon will most likely provide a saline spray. Use it as instructed to keep your nasal passages moist and clean. Gentle nasal cleaning with a cotton bud and hydrogen peroxide/saline may also be recommended.

You may shower, but take care not to get the plaster wet. When washing your face, avoid the area around your nose.

Do not wear glasses or sunglasses that rest on your nose. Your surgeon will tell you when it is safe to do so.

Only wear clothes that fasten at the front or have a zip. Avoid clothes that you pull over your head.

Weeks 2-4

Significant bruising and swelling will largely subside.

You may resume non-strenuous daily activities and return to work.

The tip of your nose may feel numb and stiff.

You may begin light walking. Avoid activities that raise your blood pressure (running, weightlifting, intense yoga). Follow your surgeon's recommended schedule.

Your nose will be very sensitive to the sun. Sun exposure can worsen swelling and cause discoloration. Wear a wide-brimmed hat and apply high SPF (SPF 30+) sunscreen when going outside.

You may try sleeping on your back, but if swelling persists, continue to keep your head elevated.

You may gently clean your nose and apply the recommended ointments.

Months 1-12 (Long-term improvement)

80-90% of the swelling subsides within the first 2-3 months, but the remaining 10-20%, particularly at the tip of the nose, may take up to a year (sometimes even longer) to disappear completely.

As the swelling decreases each month, you will notice positive and subtle changes in the shape of your nose.

Be aware that the final result will not be the shape you see after 1 month. Trust the process.

Attend your surgeon's scheduled check-ups (3 months, 6 months, 1 year) regularly so they can monitor your recovery.

You will be cleared for contact sports and strenuous exercise, but always protect your nose from injury.

Observe how your nose becomes more defined and refined as the months pass.

Ultrasonic rhinoplasty cost

There is no single fixed price, as the cost varies dramatically based on location, the surgeon's expertise, and the complexity of your case. However, to give you a realistic range:

In the United States: Ultrasonic Rhinoplasty typically ranges from $12,000 to $25,000+.

In Turkey and Europe: The range is generally €5,000 to €12,000

How to choose the right surgeon?

To find the right surgeon, you can use the following criteria:

Ensure that the surgeon is a plastic, reconstructive, and aesthetic surgery specialist, and check the surgeon's certificate of specialization.

Confirm that the hospital and clinics are licensed.

A surgeon who performs this operation frequently will be more technically proficient.

Find out if the surgeon has experience with cases similar to yours (e.g., wide nose, revision, ethnic nose). Review previous patient photos of similar cases. Are the results natural, personalized, and compatible with the patients' original facial features?

If you are considering ultrasonic (piezo) rhinoplasty, ask whether the surgeon has received specialized training in this technique and uses it regularly. Simply owning the device is not sufficient; being able to use it effectively is crucial.

Meet with the surgeon face-to-face. The surgeon should listen patiently to your expectations, fears, and complaints.

The surgeon should clearly explain the limitations, risks, and realistic outcomes of the surgery. A confident surgeon conveys their knowledge calmly and clearly.

The surgeon should explain a surgical plan tailored specifically to you. There should be no standard approach that gives the impression that 'everyone will have the same nose.'

It is important that the center where you will have your surgery is hygienic, modern, and fully equipped.

Quality, experience, and safety should always be your priority. However, find out exactly what the price covers (surgery, hospital, anesthesia, check-ups, etc.).

Best ultrasonic rhinoplasty surgeon in Zürich

To find the right ultrasonic rhinoplasty surgeon in Zurich, you can follow these steps:

Before searching for a surgeon in Zurich, check the websites of official organizations such as the Swiss Society for Plastic, Reconstructive and Aesthetic Surgery (SGPRAC). Surgeons listed here have been approved by recognized boards of specialists.

Review the clinics' websites. Do they explicitly mention the piezo technique? Try to understand how much they focus on rhinoplasty.

Look not only for the best results, but also for consistency. Do all the noses the surgeon performs look the same, or do they produce natural and personalized results tailored to each patient's face?

One of the clinics in Zurich that performs ultrasonic rhinoplasty is Swiss Nose Clinic. Swiss Nose:

Area of expertise: The clinic's main focus is rhinoplasty. This is a positive aspect in terms of a surgeon being highly experienced in a specific procedure. Swiss Nose offers ultrasonic rhinoplasty services with its team of expert and experienced surgeons.

Use of technology: Swiss Nose has invested in this modern technique, and its surgeons apply the Piezo (ultrasonic) rhinoplasty technique with great skill.

Case studies: It has an extensive 'before and after' photo gallery. Carefully examine these photos to evaluate the surgeon's style and consistency.

Communication: Experienced in serving international patients, it has a well-structured and organized system for communication and coordination.

If you require ultrasonic rhinoplasty, you can contact our surgeons at the clinic for detailed information.

F.A.Qs

Is piezo ultrasonic rhinoplasty painful?

No, it is generally less painful than the traditional method. As the procedure is performed under general anesthesia, you will not feel anything during the operation.

Is ultrasonic rhinoplasty better?

In many respects, yes. In cases requiring bone work, it is more precise, controlled, and safer than the traditional method.

Is ultrasonic rhinoplasty permanent?

Yes, it is permanent. Bone and cartilage tissue removed using the piezo technique does not regrow. The nose permanently retains the new structure shaped by the surgeon. However, the nose may undergo very slight changes naturally as part of the aging process; this is a normal process applicable to all types of rhinoplasty.

Is ultrasonic rhinoplasty safe?

Yes, it is extremely safe when performed by an experienced surgeon.

What kind of anesthesia does piezo ultrasonic rhinoplasty require?

Piezo rhinoplasty is usually performed under general anesthesia. This is the most suitable method for patient comfort and the surgeon's precise work. This way, you will not feel any pain or discomfort during the operation.

How long after piezo ultrasonic rhinoplasty can I wear glasses?

You should not wear glasses or sunglasses that put pressure on your nose for at least 4-6 weeks. This period is necessary for the bones to fuse and stabilize in their new position. Wearing them too early can cause unwanted deformities.

When can I swim in the pool or sea after piezo rhinoplasty?

To prevent wound healing complications and infection risk, you should wait at least 4-6 weeks before entering a pool, sea, or hot tub. This period is necessary for the complete healing of internal and external incisions and for the reduction of the risk of infection in the nasal tissue.

When can I start sports after piezo rhinoplasty?

• Light walking: Can be done after the first week.
• Light cardio (running, cycling): Generally possible after 2-3 weeks.
• Strenuous sports and weight lifting: You should wait at least 4-6 weeks. For contact sports (basketball, football) where there is a risk of impact to the nose, you must obtain your surgeon's approval and wait at least 3 months.

When can I travel by plane after piezo rhinoplasty?

After the tampons and plaster cast have been removed, short flights are generally possible one week after surgery. However, the pressure changes during takeoff and landing may be uncomfortable. The ideal time for long-haul flights and full recovery is 2-4 weeks later. Always consult your surgeon before flying.

Showering after the piezo technique

You can usually shower the day after surgery. However, great care must be taken not to get the plaster/bandage on your nose wet. You should shower standing up, using lukewarm water, without holding your face under the water or bending over. After the plaster is removed (1 week), you can continue to gently clean and wash the nasal area.