Sonic rhinoplasty: histologic correlates and technical refinements using the ultrasonic bone aspirator

Overview

Nasal bone is traditionally reshaped with chisels and rasps. An ultrasonic bone aspirator removes bone in a controlled, graded way while sparing soft tissue. The authors extend its uses in rhinoplasty, examine tissue samples under the microscope, and report outcomes from an academic facial plastic surgery practice.

Sections of note

• Retrospective review of 103 consecutive cosmetic rhinoplasty patients at a tertiary academic practice.
• New applications: reducing the nasal spine, deepening the glabella, sculpting mobile bone fragments after osteotomy, smoothing bony edges after medial osteotomy, and reducing nasal bone convexity.
• Histologic analysis of cartilage samples was performed.
• Aesthetic outcome judged subjectively by patient and surgeon; all patients obtained satisfactory outcomes.
• 7 minor complications: 1 visible dorsal irregularity, 2 palpable but not visible irregularities, 2 dorsal asymmetries, 2 under-resected dorsums.
• No skin or soft tissue injury.

What it means for a patient

• Ultrasonic bone removal lets the surgeon take bone down a little at a time and smooth edges that chisels leave.
• In this series problems were minor, and about 1 in 15 patients had a small irregularity or asymmetry.
• One practice, subjective outcome rating and no comparison with conventional instruments; the histology findings are not described in the abstract.

Why this paper matters

This paper predates the wider "piezo" ultrasonic rhinoplasty movement and documents an early expanded use of ultrasonic bone tools in the nose. Whether ultrasonic instruments reduce swelling, bruising or revision compared with chisels is not tested here.

Terms

• Ultrasonic bone aspirator: a powered tip that vibrates at ultrasonic frequency to remove bone while suctioning debris.
• Osteotomy: a controlled cut through nasal bone to move it.
• Medial osteotomy: the bone cut made near the midline of the bridge.
• Nasal spine: the small bony point at the base of the septum above the upper lip.
• Glabella: the flat area of the forehead between the brows.
• Histologic analysis: examination of tissue under a microscope.