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The first modern rhinoplasty was performed in 1887 in the United States by Dr. John Orlando Roe, an otolaryngologist from Rochester, NY. In fact, he is considered the father of aesthetic rhinoplasty.
Over the years, even as the procedure itself has become a more sophisticated undertaking, much about the operation has remained the same. Despite advances in the understanding of the structure and function of the nose, ethnic nasal differences, the social and psychological aspects of rhinoplasty and long-term outcomes, most rhinoplasty surgeons basically perform the same operation.
Most patients who come seeking rhinoplasty have a similar concern. They think that their nose is too big and that it doesn't harmonize with their facial shape. The procedure that they invariably get is called a reduction rhinoplasty. This is a rhinoplasty that makes the nose smaller. Typical features of a large nose can be the presence of a large hump, wide nasal bones, a bulbous nasal tip and/or wide nostril position.
Excess cartilage and bone in the nose need to be managed to make the nose smaller. Management of the nasal bones has been handled in basically one way: use rasps, hammers and surgical chisels to lower the hump and narrow the nasal bones. In 2004, this changed with the introduction of ultrasonic, or piezoelectric, rhinoplasty by Dr. Massimo Robiony. This technique employs a device that uses high-speed sound waves to vibrate tiny cutting and shaving tip inserts.
Piezoelectric inserts (PEI) have the ability to selectively act on bones and/or hard cartilage, without injuring soft tissues: skin, mucosa and flimsy cartilages such as the upper lateral cartilages and lower lateral cartilages. Importantly, the fracture lines created by PEIs are very accurate and eliminate the risk of radiating fracture lines encountered with traditional rhinoplasty instruments.
The theory is that with less surrounding trauma, you decrease the amount of surgical bleeding, post-surgical bruising, swelling and pain from a rhinoplasty procedure while also creating a more accurate cosmetic outcome. This, in turn, should lead to less need for revision surgery. Current national revision rates for rhinoplasty surgery run over 30 percent.
Ultrasonic rhinoplasty is a little different from a traditional rhinoplasty in the fact that your surgeon has to undermine the skin of the nose more extensively to fit the device. Also, the device can only be used in open rhinoplasty procedures. Open rhinoplasty procedures require external skin incisions to expose nasal structures.
Detractors of open rhinoplasty procedures point to the increased swelling and scarring in the nasal tip related to making the open incision in the columella of the nose. The columella is the fleshy divider of the nostrils. Future advances in ultrasonic technology will allow the procedure to be performed in patients wanting a closed (or endonasal) rhinoplasty.
The procedure has many practitioners in Europe and Turkey, and the FDA approved the device for use in November 2017. Though few plastic surgeons offer the procedure at present, ultrasonic rhinoplasty is expected to be more widely available in time, giving patients more options to change the shape of their nose.
If you are considering any rhinoplasty procedure, please be sure to use the ASPS Plastic Surgery Connect referral service to find a board-certified plastic surgeon in your area.
The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.