Ultrasonic Rhinoplasty

Ultrasonic Rhinoplasty – The Latest Advancement In Rhinoplasty Surgery

Mr Chana offers the latest technique of ultrasonic rhinoplasty which is a refined technique of improving the results and recovery from nasal reshaping procedures. He was one of the first surgeons in the UK to offer this technique and has been performing this procedure since 2016 when the technique first became available. Over this time he has hundreds of patients who have benefitted from this technique . The technique is also called a Piezo-rhinoplasty.

Mr Chana featured in the National Media as an authority in this technique in 2018 and you can read the full article on the ultrasonic rhinoplasty technique here

Ultrasonic rhinoplasty surgery utilises ultrasonic energy to reshape the bone. Altering the shape, profile and width of the nasal bones is one of the key steps involved in producing good results from rhinoplasty. In fact, the majority of nose reshaping procedures involve reducing the size of the bony hump and also narrowing the width of the bone in order to make the nose smaller and more streamlined in appearance.

The advantages of the ultrasonic rhinoplasty surgery are:

More precise bone sculpting
Less risk for bone irregularities and unwanted microfractures during surgery
Enhanced bone healing
Less soft tissue trauma and less bruising
Often the nasal bones do not need to be broken

How is an ultrasonic rhinoplasty surgical procedure performed ?

Current techniques are quite traumatic since abrasive instruments such as rasps and osteotomes are used to file down and chisel the bone. These techniques have a risk of leaving fine irregularities on the bone, risk unwanted microfractures and also cause quite considerable tissue trauma both to the bone and to the surrounding soft tissues. As a result there is considerable swelling and bruising which prolongs the healing time. There are also greater risks of the bone and tissues healing irregularly in the months after the rhinoplasty which often results in the accepted risk of having to undertake revisional surgery in a proportion of cases.

The technique uses an open approach to provide access to the nasal bones. The equipment for the procedure is called a Piezotome and it comes with a hand-piece. Within the machine there a crystals called piezo-electric crystals that respond to an electric current with a high frequency oscillation which is then transmitted to the tip of the device as ultrasonic energy. These ultrasonic vibrations of the tip when in contact with bone cause microcavitation in the bone in a very precise manner even with very gentle application to the surface of the bone. This allows a very precise method of bone sculpting. The tips for the device come in different forms to allow gentle sculpting or to provide very precise bone cuts in a manner which simply not possible with conventional instruments.

It should be made clear that the ultrasonic rhinoplasty is beneficial only for the bone surgery and does not aid the modifications to the cartilages or the septum. It is therefore not a technique that applies to every aspect of rhinoplasty. Modifications to to the nasal tip or the dorsal cartilages ( below the nasal bones) are best performed using modern 'Preservation Rhinoplasty' techniques rather than aggressive removal which leads to future instability, In Preservation Rhinoplasty the tissues are preserved by reshaping rather than removal by folding, using sutures or lowering the position. Such techniques can be combined with ultrasonic rhinoplasty and are termed a hybrid technque of ultrasonic and preservation rhinoplasty. The before and after photos that you will see on this website have been carried out using these latest techniques.

Watch the video below of London based Mr Chana explaining how an Ultrasonic Rhinoplasty surgeryis performed:

You can see the device for used for an ultrasonic rhinoplasty is shown here. The machine generates the ultrasonic energy which is then transmitted to the handpiece. This handpiece transmits the ultrasonic energy to reshape the bone. This handpiece can be fitted with a myriad of different types of tips which come in various shapes and sizes according to the particular type of function or purpose required during the rhinoplasty.

What is the recovery from an ultrasonic rhinoplasty ?

The typical recovery is with hardly any pain but which can be more descibed as discomfort or 'pressure' in the nose. Such symptoms are easily controlled with mild painkillers which will be prescribed. There will be a nasal cast for a week in most situations although in certain forms of ultrasonic rhinoplasty or preservaion rhinoplasty a cast may not be needed and there will simply be nasal tape which is applied.

In standard rhinoplasty the reputation is one of black and blue severley swollen eyes and nose. However, this does not occur and for most patients there will be very little or no bruising. If there is bruising it tends to be very mild and should dissipate by the time the dressings and cast is removed at 1 week.

In the video below you can watch the experience of my patient just as the cast is removed at one week. You will note that she no bruising and minimal swelling:

Who is suitable for ultrasonic rhinoplasty surgery ?

This technique is suitable for those types of rhinoplasty where bone sculpting is required and includes:

Dorsal humps
Large nasal bones
Bone irregularities
Wide nasal bones
Nasal bone deviations

Who is not suitable for ultrasonic rhinoplasty surgery ?

When bone surgery is not required the ultrasonic technique is not suitable. This includes the following situations :

Tip rhinoplasty
Nostril reduction
Augmentation rhinoplasty ( to raise the bridge line or make the nose larger)

What are the risks from ultrasonic rhinoplasty surgery?

There is no doubt that ultrasonic rhinoplasty has improved the overall technique with advantages in recovery with enhanced bone healing and less bruising. However, the general risks of rhinoplasty still apply. The overall settling period of all the tissues will still be approximately a year before the final result can be fully appreciated. Although the risks of bone irregularities is reduced this can still occur depending on the degree of work required on the nasal bones although in general the risks are less compared to conventional rhinoplasty. This does mean that minor adjustments and refinement procedures may still be needed in a small proportion of cases.

You can read more about the risks of rhinoplasty on the main rhinoplasty page.

Is Ultrasonic Rhinoplasty suitable for revision rhinoplasty surgery?

Many patients who have had an unsatisfactory result from a previous rhinoplasty assume that ultrasonic rhinoplasty is a magic wand that will correct their nose, This is not the case. Revision rhinoplasty requires a careful analysis of various structures of the nose to determine which aspects can be corrected . This may require bone surgery, cartilage adjustments and ven grafts to restore a satisfactory appearance. The use of ultrasonic techniques may be useful for a part of such a procedure to aid any bone surgery but it is not an all encompassing technique which will address every aspect of the revision surgery. Most often various types of grafts are required in revision rhinoplasty and this will form the dominant part of the procedure.

No bruising at the 1 week cast removal

CaseStudy Content :

This lady demonstrates typical features of a large nose with a significant bony hump which she requested to be reduced in size. Using normal techniques this degree of bone reduction would require extensive rasping or reduction with an osteotome (chisel) which are relatively crude instruments. In this case the ultrasonic rhinoplasty plastic surgery technique of bone reduction was used with minimal bruising as can be seen in the one-week post-surgical photo below as the cast has been removed.
One-week post-operative appearance after removal of the cast demonstrating minimal bruising.

The result is shown below at 6 months. The ultrasonic technique is particularly useful for aiding the correction of a crooked nose. You can see below this same lady had a deviation of the nasal bones which has been straightened together with the dorsal reduction.
Ultrasonic rhinoplasty for dorsal reduction and correction of deviation

CaseStudy Content :

This patient had a deviated nose and rerquested an overall reduction in size of her nose. An ultrasonic technique was used and you can see a straightening has been achieved.

The result is shown below to show both the front and side views.

Click the link below to watch the video of this patient's journey. In particular pay attention to when the cast is removed at only 1 week where hardly any bruising is seen.

Click here to view video

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What types of noses can be improved with ultrasonic rhinoplasty plastic surgery?

Almost any type of reduction rhinoplasty can be suitable for this technique. Most forms of nose reshaping which involves reducing a dorsal hump or narrowing the width of the nasal bridge is suitable. It is also useful for correcting deviated noses where there is a significant bony deviation. The technique does not help other structures such as the soft tissues include the septum and other nasal cartilage s which often need to be adjusted to improve nasal shape. These manoeuvres can easily be undertaken in the usual manner in combination with the ultrasonic bone reshaping.

What is the recovery after ultrasonic plasty plastic surgery?

In terms of recovery the main advantage of this technique is less bruising and enhanced recovery times. Individuals will vary in terms of the extent of bruising that can occur following rhinoplasty and this can also vary according to the extent of surgery which is required. In general bruising tends to last approximately 2 weeks with rhinoplasty surgery but with this technique the degree of bruising is reduced. Other factors involved with the rhinoplasty recovery are similar to standard techniques. You will still need to wear a cast or splint for approximately one week after surgery and incisions also need to heal. It is important to realise that with any surgery it can take over 6 to 9 months or longer to fully appreciate the final results.