Combining Piezo and Power Tools for a Better Outcome in Hybrid Structural-Preservation Rhinoplasty

Robotti E, Khazaal A, Leone F, De Bernardis R, Nolli M, Robotti S, Cottone G.

What this paper says

Robotti's group describes how to combine powered burrs (for reshaping bone) with ultrasonic piezo inserts (for cutting bone) across the steps of a hybrid rhinoplasty, drawing on more than 350 cases at two centres over three years.

Overview

Ultrasonic piezo devices have become popular for bone cutting; powered burrs are less discussed. This technique article explains how burrs with spherical, cylindrical, conical and discoid tips fit alongside piezo inserts in a logical sequence, focused on the senior author's modified dorsal-split preservation hybrid but applicable to structural or preservation surgery. No outcome data are given; Level of Evidence V.

Sections of note

General rule: burrs for reshaping, piezo for cutting bone, with stated exceptions.
Claimed benefits: more control, fewer asymmetries, smoother bony and middle-vault contour, more precise septal and turbinate work.
Experience base: over 350 patients at two centres over three years.
Cost of the equipment is acknowledged.

What it means for a patient

Modern rhinoplasty bone work increasingly uses powered instruments rather than hammer and chisel; this paper explains which tool does what.
The claimed advantages are the authors' judgment from experience, not measured against conventional tools.

Why this paper matters

It is a practical guide from an influential revision surgeon on integrating two instrument systems. Limits: expert opinion, no comparative data.

Terms

Piezo (piezoelectric) instrument: an ultrasonic tip that cuts bone but not soft tissue.
Power tool / burr: a rotating cutting head used to shave or smooth bone.
Hybrid rhinoplasty: an operation combining structural and preservation steps.
Dorsal split: a preservation variant that divides the dorsum in the midline to allow lowering.
Turbinates: shelves of tissue inside the nose that can be reduced to improve airflow.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Over the past decade, rhinoplasty has seen an unprecedented evolution in concepts, techniques and tools. New concepts have led to new techniques, prevalently but not exclusively related to preservation rhinoplasty, and the use of new tools has made such techniques easier, more precise and thus better reproducible.…”

Excerpt; the full abstract is on PubMed.