What is Ultrasonic Piezo Rhinoplasty Your Faqs Answered | Dr. Thomas Buonassisi
Dr. Thomas Buonassisi, MD, FRCSCDr. Thomas Buonassisi, MD, FRCSC — Otolaryngology – Head & Neck Surgeon with a practice limited to facial plastic surgery, 8 West Clinic, Vancouver, BC.
Published July 27, 2026·Medically reviewed by Dr. Buonassisi
KEY TAKEAWAYS — IN THIS VIDEO
Ultrasonic rhinoplasty uses a piezotome for precise bone modifications.
This technique reduces trauma and bruising compared to traditional methods.
Ultrasonic tools are especially useful for thick nasal bones and precise adjustments.
The permanence of rhinoplasty results is unaffected by the choice of ultrasonic tools.
The surgeon's experience is crucial for successful rhinoplasty outcomes.
Dr. Buonassisi · What is Ultrasonic Piezo Rhinoplasty Your Faqs Answered | Dr. Thomas Buonassisi
Dr. Thomas Buonassisi, MD, FRCSC — Otolaryngology – Head & Neck Surgeon with a practice limited to facial plastic surgery, 8 West Clinic, Vancouver, BC.
Dr. Buonassisi is certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) and the American Board of Otolaryngology – Head and Neck Surgery (ABOHNS), and is a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCSC) and the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). He co-founded 8 West Clinic — a rhinoplasty-focused practice in Vancouver, BC — with his wife Angie Buonassisi, with two locations in Vancouver and North Vancouver, with patient education as a founding principle of the practice.
Dr. Buonassisi has been educating patients on rhinoplasty for over 15 years and has published hundreds of educational videos across YouTube and Instagram — with content going back over a decade. Every article and video in the Knowledge Hub is written or reviewed directly by Dr. Buonassisi.
Ultrasonic rhinoplasty involves the use of a piezotome or ultrasound device to perform bone work in rhinoplasty. This technique is particularly useful for tasks such as hump reduction and narrowing of the nasal bones. The piezotome allows for precise cuts and modifications, which are essential in achieving the desired aesthetic and functional outcomes.
Dr. Thomas Buonassisi, MD, FRCSC — Specialist in Otolaryngology – Head and Neck Surgery, with a practice limited to facial plastic surgeries — explains that while ultrasonic tools are not necessary for every case, they are invaluable when dealing with thick nasal bones or when precision is paramount, such as in preservation rhinoplasty.
How Does Ultrasonic Rhinoplasty Work?
The piezotome allows for gentle and precise cuts through the nasal bones, maintaining the integrity of surrounding soft tissues. This precision is achieved by using high-frequency oscillations to cut the bone without exerting excessive pressure. Dr. Buonassisi demonstrates this by comparing it to making a gentle cut through a thin tongue depressor, illustrating how the tool can fracture the bone exactly where desired.
This method contrasts with traditional techniques that require more force, such as chiseling, which can lead to unpredictable fracture lines and more trauma to the surrounding tissues.
Benefits of Ultrasonic Rhinoplasty
One of the primary benefits of using ultrasonic technology in rhinoplasty is reduced trauma to the surrounding soft tissues, which often results in less bruising post-surgery. Dr. Buonassisi notes that while the bone itself does not bleed significantly, traditional tools can damage soft tissues, leading to increased bruising.
Additionally, the precision of the piezotome allows for more controlled modifications, such as drilling tiny holes for sutures, which can help in stabilizing the nasal bones during healing.
When is Ultrasonic Rhinoplasty Used?
Ultrasonic rhinoplasty is particularly beneficial in cases requiring modification of the nasal bridge, such as altering the bridge height or width. It is not typically used for procedures involving only the cartilaginous structures of the nose, such as tip refinement.
Dr. Buonassisi emphasizes that while ultrasonic tools offer significant advantages in certain scenarios, the key to a successful rhinoplasty lies in the surgeon's experience and expertise. The choice of tools is secondary to the skill and judgment of the surgeon.
Is Ultrasonic Rhinoplasty Permanent?
Like all rhinoplasty techniques, ultrasonic rhinoplasty aims to create permanent changes to the nasal structure. The use of ultrasound technology does not alter the permanence of the results compared to traditional methods. However, it may enhance the healing process by minimizing initial bruising and trauma.
Patients often inquire about the longevity of results, and Dr. Buonassisi assures that the changes made during ultrasonic rhinoplasty are intended to be lasting, similar to those achieved with conventional techniques.
Full Transcript
Ultrasonic rhinoplasty refers to the use of a piezotome or an ultrasound device to do the bone work involved in rhinoplasty. So rhinoplasty has lots of different components to it. The bone work, which is really hump production, narrowing of the nose bones. Sometimes we need to drill some tiny little holes so that we can put sutures through bone. Those are the parts of the rhinoplasty where ultrasound is extremely useful. So why do we use piezotome or ultrasound device in rhinoplasty? The main reason is for its accuracy. Now I don't use it in all cases. There are situations where I don't really need to use it. But when I have thick nose bones or if I wanna be very, very precise about how much I mobilize the nose bones, for example, in a preservation rhinoplasty, then I think the ultrasound is very useful for that. So as an analogy, what I'm gonna do is I'm gonna take this very thin tongue depressor, which is probably similar to the thickness of nose bones. So remember, the nose bone is on a block. There's a nose bone on each side of the nose. They're thin. They have a certain shape and length to them. If I want to make the nose bones come inwards, I can fracture them with a chisel. I can push them inwards. I can, you know, file them down with rasps. But what I like to do is make a very, very gentle cut through the nose bones, keeping all the soft tissue around it intact, and that helps to stabilize things after. So if I wanted to cut through the nose bone, for example, here, at that point, if I fracture that with a chisel or if I push it in sort of manually, that fracture line can be anywhere, and it may not necessarily fracture right where I want it to. With a piezotome, what I can do is I can take that fracture line, and I can actually encourage it to fracture exactly where I want it by cutting through the bone. So I'll show you how I do that. This is the actual tool that I use. And I basically just make a very gentle cut. I'm barely even pushing on this. You'll notice that the tongue depressor is not even flexing. It's not like I'm pushing **** ** it. It's very, very gentle strokes. So now that I've cut through the majority of the bone, in this case, tongue depressor, the tissues on the other side of the bone are still intact. And so once I've made that initial cut, I can fracture the nose bone exactly where I want it. So you'll notice that it's still attached on the undersurface, and we actually do that with rhinoplasty as well. If I want those nose bones to move in but be stable, I can maintain the attachments on the undersurface. So I find this is much more predictable than when I, when I just fracture it with a chisel. So you can sort of see I can get a little bit of a bend in the in the in the tongue depressor. In in the case with rhinoplasty, we're getting the nose bones to bend inwards. But it remains a bit more stable. So I like that. The other thing I'll sometimes do with the piezotome is once I've mobilized the nose bones, if I want them to stay in a very particular position, there's another little trick I like to use. This is an ultrasound drill. It's not actually sharp. I can touch myself with it. I wouldn't poke myself in the eye, but it would it's not particularly sharp. But I can actually make a hole with this. And so sometimes after I fracture the nose bones, I'll make a tiny little hole, and this is really easy to do and super fast. I make a little hole, and then I can put a stitch through the hole. One of the things I like to do if I wanna bring nose bones together, so if I've got a nose bone on one side that I wanna bring in and a nose bone on the other side that I wanna bring together, I often will use the piezo tom to drill a little hole through the nose bone, create a little space, and then I can put a suture through that. And then I can take that suture, bring it to the other side, and then when I tie the suture, it will bring the nose bone actively inward. And so it's a really nice way to narrow the nose bones, without causing much trauma to them. So a little hole in the nose bone plus a stitch across to the nose bone on the other side can can bring those nose bones together and keep them tight during the healing process. So, another great use for this. I find it very difficult to get a drill in there to drill these holes, whereas the Piazza Tome, I can make a hole through the nose bone that's just really gentle and takes me about five seconds. So you can see I've got a couple little holes in there already, and it's easy to do with the Piazza Tome. So, you know, again, there's different tools that can be used to do the fractures in the nose mold so that we can narrow the nose, which we wanna do in a lot of our cases, whether you use chisels or rasps or even saws. I think there's lots of different ways of doing it. I like the piezotone particularly when the nose bones are thick. I find it to be very accurate, and I do think it causes less bruising because it's not really traumatizing the surrounding tissue quite so much. Really useful tool. I use it all the time. It's not absolutely necessary in all cases, just depending on what I'm doing. But it speeds things up and it's very gentle. It's different from traditional techniques because we're use first of all, we're using a powered source to modify the nose bones so things can be done a little bit more quickly. The other thing is that because it's the ultrasound is is oscillating at a very, high frequency, we can actually make cuts in the nose bone or remove nose bones without actually having to put a lot of pressure on them. So if I were to use a chisel to fracture a nose bone, which I do, I have to put a fair bit of force on that with a little tiny mallet. So you need to sort of force the chisel through the tissues a little bit more firmly. Still an effective way to do it, and lots of people do it that way, but it does require a little bit more force. The other thing is that because we're doing it gently with ultrasound, the surrounding soft tissues are not damaged. I could use the ultrasound on my finger and it wouldn't do anything. So it's it's a nice, safe, and less traumatic way of mobilizing the nose bones or modifying them as part of the rhinoplasty. It's not all of it. You can't do the entire rhinoplasty just with ultrasound. There's other other devices and there's other instruments that you need to use, particularly on the cartilaginous parts of the nose. But this helps to speed up the process and I think is a little bit less, traumatic, than the techniques I used to use. We actually have patients ask if ultrasonic rhinoplasty is permanent, and it really is no different from other rhinoplasty techniques. The idea behind rhinoplasty is to make a long term permanent change to the known. Yes, using the ultrasound does make permanent changes, but so do the other surgical tools that we use. Bruising typically is less with ultrasonic rhinoplasty because we're traumatizing the surrounding tissues less. So generally speaking, the bone doesn't bleed a lot, whether you use a chisel or whether you use ultrasound. However, the surrounding soft tissues, because the chisels are quite large, often do get a bit of damage to them and they tend to bleed more. The bleeding results in bruising. So bleeding from osteotomy sites on the nose tends to travel to around the eye. So yes, I think that the amount of bruising that we get with ultrasonic rhinoplasty is less than when we use traditional instruments. But keep in mind, that bruising goes away either way. So long term, I don't think it makes a big difference for bruising three, four weeks after the surgery. But certainly in the first week, I notice the bruising is less. I think the ultrasonic rhinoplasty technique can be used in any rhinoplasty case where modifications to their bones are required. So if there's a case where someone just needs modification of the tip or narrowing of the tip, these are all cartilaginous structures. There's no reason to use or usefulness for the piezotome. However, if modification of the bridge height, the bridge width, the areas where we need to drill tiny little holes in the bone to secure things, then the piezo tom or the ultrasonic rhinoplasty tool is extremely helpful. The question was, is ultrasound or rhinoplasty better than traditional rhinoplasty? And, you know, I think that's difficult to say. The most important thing with rhinoplasty is the experience of your surgeon. So an ultrasound doesn't give you a good rhinoplasty. An experienced rhinoplasty surgeon is going to give you the best result.
[
{"href":"/rhinoplasty-knowledge-hub/what-exactly-is-rhinoplasty","title":"What Exactly Is Rhinoplasty?"},
{"href":"/rhinoplasty-knowledge-hub/male-vs-female-rhinoplasty-differences","title":"Male vs Female Rhinoplasty Differences"},
{"href":"/rhinoplasty-knowledge-hub/non-surgical-rhinoplasty-vs-surgical-rhinoplasty","title":"Non-surgical Rhinoplasty vs Surgical Rhinoplasty"},
{"href":"/rhinoplasty-knowledge-hub/two-day-post-op-dressing-suture-care","title":"Two Day Post-op Dressing & Suture Care"},
{"href":"/rhinoplasty-knowledge-hub/two-month-rhinoplasty-follow-up-results","title":"Two Month Rhinoplasty Follow-up Results"},
{"href":"/rhinoplasty-knowledge-hub/early-recovery-expectations-after-rhinoplasty","title":"Early Recovery Expectations After Rhinoplasty"},
{"href":"/rhinoplasty-knowledge-hub/common-nasal-features-patients-want-most","title":"Common Nasal Features Patients Want Most"},
{"href":"/rhinoplasty-knowledge-hub/setting-realistic-rhinoplasty-expectations","title":"Setting Realistic Rhinoplasty Expectations"},
{"href":"/rhinoplasty-knowledge-hub/hollys-rhinoplasty-consultation-journey","title":"Holly's Rhinoplasty Consultation Journey"},
{"href":"/rhinoplasty-knowledge-hub/closed-vs-scarless-rhinoplasty-explained","title":"Closed vs Scarless Rhinoplasty Explained"},
{"href":"/rhinoplasty-knowledge-hub/severe-septal-deviation-rhinoplasty-results","title":"Severe Septal Deviation Rhinoplasty Results"}
]
