Piezoelectric Versus Conventional Rhinoplasty: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials

Armanfar S, Ardakani MR, Vahidiataabadi M.

PubMed 42013314 Publisher (DOI)

What this paper says

Across 19 randomised trials with 905 patients, ultrasonic (piezoelectric) bone cutting produced less swelling, bruising and pain in the first week and no cases of mucosal tearing, with no clear difference in operating time.

Overview

Piezoelectric devices cut bone with ultrasonic vibration and spare soft tissue, unlike traditional chisels (osteotomes). The authors searched databases and trial registries to 1 December 2025 for randomised trials comparing the two, following PRISMA and registered in PROSPERO. Nineteen trials (476 piezo, 475 conventional) qualified and 15 were pooled with random-effects meta-analysis; ROB-2 and GRADE were applied.

Sections of note

Oedema favoured piezo at day 2 (SMD -0.92; 95% CI -1.70 to -0.13) and day 7 (SMD -0.64; -1.06 to -0.22), but not at days 1, 3 or 4.
Ecchymosis was reduced at day 1 (SMD -1.33), day 2 (SMD -1.13) and day 7 (SMD -0.62).
Pain at day 2 was lower with piezo (SMD -1.23; -1.90 to -0.57).
Mucosal integrity loss: none in piezo cases; RR 0.09 versus controls (95% CI 0.02-0.44).
Osteotomy duration did not differ significantly, with high heterogeneity. Level of Evidence 2.

What it means for a patient

Piezo bone work gave a visibly easier first week: less bruising and swelling around the eyes and less pain at day 2.
It did not tear the inner nasal lining in any pooled trial, a possible long-term advantage.
The review did not assess final shape or breathing, so it does not show a better end result.

Why this paper matters

It is the largest randomised-trial synthesis on piezo osteotomy, with formal certainty grading. Limits: outcomes limited to the first week, variable measurement scales, operative time uncertain.

Terms

Piezoelectric osteotomy: cutting bone with an ultrasonic tip that does not cut soft tissue.
Osteotome: a surgical chisel used to fracture nasal bones.
Standardised mean difference (SMD): a unit-free effect size; -0.5 is a moderate reduction.
GRADE: a system for rating certainty of evidence.
Mucosal integrity: intactness of the nasal lining beneath the bone cut.

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

From the abstract

“Piezoelectric osteotomy may reduce postoperative morbidity after rhinoplasty but time-based effects remain uncertain. The aim of this review was to understand the time-based effectiveness and safety of piezoelectric osteotomy vs conventional methods. A search was performed of major databases and trial registries from…”

Excerpt; the full abstract is on PubMed.