Optimizing Closed-Approach Preservation Rhinoplasty by Ultrasonic Piezo-assisted Techniques for Enhanced Precision

Guilarte R, Malzone G.

PubMed 39812015 Publisher (DOI)

What this paper says

In 734 closed preservation rhinoplasties over two years using purpose-adapted ultrasonic inserts, the revision rate was 6%, mostly for dorsal contour adjustments.

Overview

Ultrasonic (piezo) instruments cut bone precisely, but inside a closed rhinoplasty there is little room to use them. Guilarte and Malzone report 734 primary patients treated from May 2021 to April 2023 with closed preservation techniques enabled by piezo instruments and specialised instrumentation to improve visibility, documenting instrument adaptation, bone-reshaping precision and complication control.

Sections of note

734 primary rhinoplasty patients, closed approach, May 2021 to April 2023.
Revision rate 6%, predominantly for dorsal contour adjustment.
Minimal intraoperative bleeding, swelling and postoperative pain reported.
Woodpecker SS18 and SS4 inserts were optimised for removing the perpendicular plate of the ethmoid and for lateral and transverse osteotomies.
The authors state all osteotomies can now be done ultrasonically.

What it means for a patient

Closed, scarless preservation rhinoplasty with ultrasonic bone work is being done at high volume with about 1 in 17 patients needing a touch-up.
Most revisions were for small bridge irregularities, the known weak point of preservation.
The paper reports the surgeons' own series without a comparison group or validated outcome scores.

Why this paper matters

It is a large series showing piezo instruments can be used through the closed approach, which had been a technical barrier. Limits: retrospective, single group, no patient-reported outcomes in the abstract, product-specific instrumentation.

Terms

Closed approach: all incisions inside the nostrils.
Piezotome: an ultrasonic bone-cutting handpiece.
Perpendicular plate of the ethmoid: the bony upper back part of the septum.
Lateral and transverse osteotomies: bone cuts along the side and across the top of the nasal bones.

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

From the abstract

“Preservation rhinoplasty, particularly dorsal preservation, has gained prominence with the advent of piezoelectric instruments, which minimize trauma and enhance precision in bone reshaping. This approach presents unique challenges, especially in closed techniques, where spatial limitations complicate the use of…”

Excerpt; the full abstract is on PubMed.