Piezo-Assisted Dorsal Preservation in Rhinoplasty: When and Why

Taglialatela Scafati S, Regalado-Briz A.

PubMed 33987697 Publisher (DOI)Free full text (PMC)

What this paper says

A review of 107 consecutive preservation rhinoplasty cases using ultrasonic instruments, reporting low complication rates and presenting an anatomy based diagram for choosing the approach.

Overview

Preservation rhinoplasty aims to spare structures such as ligaments, nerves and vessels, keeping tissue handling to a minimum. The authors state this avoids the drawbacks of classic bridge reconstruction techniques, which often leave irregularities and drive up the revision rate. The article reviews their consecutive cases using a range of preservation techniques with piezoelectric instruments.

Sections of note

Review of 107 consecutive cases; the journal assigns level of evidence IV.
A variety of preservation techniques were used across the series.
Indications, surgical techniques and complications are described in the article.
All reported procedures showed low complication rates, with no figures given in the abstract.
Cosmetic and functional outcomes are described as good, without measurement.
The authors state tailoring the technique to the individual is essential.
They present an anatomy based diagram to help surgeons choose the right approach for the bridge.

What it means for a patient

Piezoelectric instruments cut bone with vibration and are intended to spare the surrounding soft tissue.
The claim of low complication rates carries no numbers, no revision rate and no follow up duration.
There was no comparison group treated with conventional instruments or conventional hump removal.
The main deliverable is a decision diagram rather than outcome evidence.

Why this paper matters

Preservation techniques depend on precise bone cuts, which is why ultrasonic instruments spread alongside them. This series reports one group's combined experience with both. Without reported rates, its claim of low complications cannot be compared with other series.

Terms

Preservation rhinoplasty: keeping and repositioning the existing framework rather than removing and rebuilding it.
Piezo instrument: a powered tool that cuts bone with high frequency vibration.
Down technique: a preservation method that lowers the whole framework, such as push down or let down.
Nasal ligaments: fibrous bands connecting nasal structures to one another.
Revision rate: the proportion of patients needing a further operation.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Preservation rhinoplasty philosophy with its "down techniques" is currently undergoing a renaissance. Its goal is to spare and preserve noble nasal structures such as ligaments, nerves and vessels, reducing to a minimum local tissue manipulation and avoiding the drawbacks and pitfalls associated with classic dorsal reconstruction techniques often resulting in irregularities which often lead to an increased rhinoplasty revision rate.

Methods: In this article, we reviewed 107 consecutive cases in which a variety of preservation techniques were used. Indications, surgical techniques and complications are also described.

Results: All reported procedures showed low complication rates with good cosmetic and functional outcomes.

Conclusions: Tailoring the surgical technique is essential in rhinoplasty. Authors have developed and present an anatomy-based diagram to help surgeons in choosing the right approach for dorsal surgery.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).