<p>Ultrasonic rhinoplasty is rhinoplasty in which the bone work is done with a piezotome, an ultrasonic device that cuts bone using high-frequency vibrations instead of a chisel. It's used for parts of the procedure such as reducing a hump, narrowing the nasal bones and making tiny holes for sutures. It's a tool chosen for the right patient, not a different operation.</p><p>In this video, <a href="/rhinoplasty-dr-buonassisi">Dr. Thomas Buonassisi, MD, FRCSC, Specialist in Otolaryngology – Head and Neck Surgery, with a practice limited to facial plastic surgeries</a>, demonstrates the piezotome on a thin wooden tongue depressor and answers questions patients often ask about it, from how it works to whether it changes bruising.</p><h2>What is ultrasonic rhinoplasty used for?</h2><p>Rhinoplasty has a lot of different parts. Some involve cartilage, mainly in the lower nose and tip, and some involve the nasal bones that form the upper part of the bridge. Ultrasonic rhinoplasty refers to using a piezotome, or ultrasound device, for the bone work.</p><p>According to Dr. Buonassisi, the parts of rhinoplasty where ultrasound is extremely useful include:</p><ul><li>Reducing a hump on the bridge</li><li>Narrowing the nasal bones</li><li>Changing the height or width of the bridge</li><li>Drilling tiny holes in the bone so sutures can pass through and hold things in place</li></ul><p>If someone only needs changes to the tip, such as narrowing or refining it, there's no reason to use the piezotome, because those structures are cartilage. Wherever the bones need to be modified, though, he finds it very helpful. The device also can't do the whole operation: other instruments are still needed, particularly for the cartilage.</p><h2>Why use a piezotome instead of a chisel?</h2><p>The main reason Dr. Buonassisi gives is accuracy. The nasal bones are thin, there's one on each side of the nose, and each has its own shape and length. To bring them inward, a surgeon can fracture them with a chisel, push them in by hand, or file them down with rasps. Those are all established methods, and he still uses a chisel himself.</p><p>The difference is control. When a bone is fractured with a chisel or pushed in manually, the fracture line can end up anywhere, not necessarily where the surgeon wants it. With a piezotome, Dr. Buonassisi makes a very gentle cut through the bone, which encourages it to fracture exactly where he intends. In the video, he shows this on the tongue depressor: light strokes, barely any pressure, and the wood doesn't even flex.</p><p>Because the device oscillates at a very high frequency, it can cut or remove bone without a lot of force. A chisel, by comparison, needs a small mallet and a fair bit of pressure to move through the tissue. He's careful to say the chisel is still effective and lots of surgeons use it. He simply finds the piezotome more predictable in his hands, especially when the nasal bones are thick.</p><p>He also likes to leave the soft tissue around the bone intact and keep the bone attached on its undersurface. That way the nasal bones can move inward but stay stable afterwards, which he shows in the demonstration as a controlled bend rather than a clean break.</p><h2>How does the ultrasonic drill help narrow the nose?</h2><p>Dr. Buonassisi also uses an ultrasonic drill for a technique that brings the nasal bones together. Once the bones are mobilized, he makes a tiny hole through the bone on one side, passes a stitch through it, and takes the stitch across to the bone on the other side. When he ties it, the suture draws the nasal bones inward and keeps them tight during healing.</p><p>He describes this as a way to narrow the nose bones without causing much trauma to them. With a regular drill, he finds it very difficult to reach the right spot, whereas the ultrasonic tool makes the hole gently in about five seconds. The drill isn't particularly sharp either, which he demonstrates by touching it to his own skin.</p><h2>Does piezo rhinoplasty mean less bruising?</h2><p>In Dr. Buonassisi's experience, bruising is typically less with ultrasonic rhinoplasty, at least early on. His explanation is about the surrounding tissue. Bone itself doesn't bleed a lot, whichever tool is used. Chisels are fairly large, though, and the soft tissues around them often get some damage and tend to bleed more.</p><p>That bleeding is what causes rhinoplasty bruising. In general, bleeding from the osteotomy sites, the places where the nasal bones are cut, tends to travel to the area around the eyes. Because the piezotome disturbs the soft tissue less, he notices less bruising in the first week.</p><p>He's also clear about the limits of that. Bruising goes away either way, and by three or four weeks after surgery he doesn't think it makes a big difference. Whatever tools are used, most people are socially presentable in about 1–2 weeks after rhinoplasty at 8 West, and final results take about 12 months to be visible.</p><h2>When does Dr. Buonassisi choose the piezotome?</h2><p>Not in every case. Dr. Buonassisi uses the piezotome often, but he's clear that it isn't necessary for every rhinoplasty and that there are situations where he doesn't need it. It depends on what each nose needs.</p><p>He finds it particularly useful in two situations. One is thick nasal bones. The other is when he wants to be very precise about how much he mobilizes the bones, for example in a preservation rhinoplasty. In general, preservation rhinoplasty is an approach centred on how the bridge is treated, keeping more of its natural structure rather than removing and rebuilding it.</p><p>That fits with how rhinoplasty works at 8 West. Every rhinoplasty Dr. Buonassisi performs is bespoke, and he uses the full range of <a href="/rhinoplasty-techniques">rhinoplasty techniques</a>, choosing between them for each patient's anatomy after a thorough consultation. The piezotome is one tool among many, and decisions about approach, such as <a href="/rhinoplasty-knowledge-hub/closed-vs-scarless-rhinoplasty-explained">closed vs scarless rhinoplasty</a>, are made the same way.</p><h2>How much does the tool matter compared with the surgeon?</h2><p>Patients sometimes ask how ultrasonic rhinoplasty compares with traditional rhinoplasty. Dr. Buonassisi's answer is that it's difficult to say. In his view, what matters more is the experience of the surgeon. An ultrasound device doesn't give someone a good rhinoplasty on its own.</p><p>At 8 West, rhinoplasty is performed by Dr. Buonassisi, who has over 25 years of experience in facial plastic surgery and has performed over 2,500 rhinoplasties. The consultation is where he assesses your anatomy, explains what is and isn't achievable, and recommends an approach. Computer imaging is used to talk through goals, as a guide rather than a promise, and consultations have a fee.</p><p>A few questions you may want to ask:</p><ul><li>Does the procedure involve bone work, or mainly the tip?</li><li>Would a piezotome be useful in this case, and why?</li><li>What can be expected for bruising in the early days?</li><li>Which other instruments or techniques would be used?</li></ul><p>We see patients from Vancouver and North Vancouver, and you can read more about the procedure on our <a href="/rhinoplasty">rhinoplasty</a> page or in our free guide, <a href="/rhinoplasty#guide">The Essential Guide to Rhinoplasty</a>. More short videos are in the <a href="/rhinoplasty-knowledge-hub">Rhinoplasty Knowledge Hub</a>.</p><h2>Frequently asked questions</h2><h3>Is ultrasonic rhinoplasty permanent?</h3><p>Yes, in the same way any rhinoplasty is. Dr. Buonassisi explains that ultrasonic rhinoplasty is no different from other rhinoplasty techniques here: the idea behind rhinoplasty is to make a long-term, permanent change to the nose. Using ultrasound for the bone work makes permanent changes, and so do the other surgical tools that are used during the procedure.</p><h3>Does ultrasonic rhinoplasty still involve breaking the nose?</h3><p>When the nasal bones need to move, yes, there is still a controlled fracture. The difference Dr. Buonassisi describes is that the piezotome makes a gentle cut through the bone first, so the bone fractures where he intends rather than anywhere along its length. He can also keep the bone attached on its undersurface so it moves inward but stays stable.</p><h3>Does the piezotome cut soft tissue?</h3><p>It's used on bone. Dr. Buonassisi explains that because the ultrasound works gently, the surrounding soft tissues aren't damaged the way they can be with larger instruments, and he says he could use it on his finger and it wouldn't do anything. Like any surgery, rhinoplasty still has risks, and these are discussed in detail at consultation.</p><h3>Does ultrasonic rhinoplasty make surgery quicker?</h3><p>Dr. Buonassisi says the powered device can make some steps of the bone work a little quicker. Making a hole for a suture, for example, takes him about five seconds. That's about the surgery itself, not recovery. After rhinoplasty at 8 West, most people are socially presentable in about 1–2 weeks, and final results take about 12 months to be visible.</p>