12 March 2017


The author shows a new rhinoplasty technique using ultrasonic bone removal to perform more precise rhinoplasties, and correct issues caused by traditional rhinoplasty tools. The ultrasonic bone aspirator uses sound waves to remove bones without damaging surrounding membranes or tissue. This allows surgeons to correct minor irregularities and asymmetry, and major deformities, like a severely deviated nasal spine.

3 thoughts on “Ultrasonic Rhinoplasty using Piezotome

  1. Olivier Gerbault says:

    Dear Philippe, first let me congratulate you for this beautiful video that shows your evolution in rhinoplasty…;))

    If I may, I would add one comment: using this extended open approach allows a perfect assessment of the whole bony vault and to tailor the osteotomies and the bone reshaping. However preserving bone stability is critical to avoid any bone collapse or other issues related to a lack of bone continuity. I’m not sure that doing outfractures the way you demonstrate is the most predictable way to narrow the bony vault while preserving bone stability.

    I personally use a different sequence, different bone management strategy, and different inserts.
    Concerning the inserts, I use as you do the Acteon Piezotome as it’s the only company that has developed specific inserts for rhinoplasty. I noticed that you use the first generation of maxillo facial inserts, that work well. But the osteotomy line of those inserts is much wider than the fine rhino piezo saws, and the curvature is not as accurate as the rhino inserts one. I also use the scraper only for significant ostectomies, as in some very strong and high radix for instance. Otherwise, the rhino saws are much more gentle and forgiving regarding potential bone defects.

    Concerning the sequence, I prefer to begin with the bone management and keep intact the cartilaginous framework that may support the bones and preserve their stability. I usually combine fine osteotomies to reposition bones and bone rasping to reshape those bones, even on the sidewalls.

    We could spend hours to talk about all this and there isn’t only one correct way to do.

    Once again congratulation for this video and for the teachnig in your departement of up to date techniques in all the fields of reconstructive and aesthetic surgery.

    Olivier Gerbault

    1. wnoel says:

      Thank you so much to register Dr Gerbault and thank you for your comment.

      If you have any video or little footage of rhinoplasty, we would be proud to publish it on wikiplastic.surgery

      Dr Noel

    2. Philippe Levan says:

      Dear Olivier,
      Thank you for your comments which are extremely instructive. As you know, ultrasonic rhinoplasty is a recent technique that you have helped to make known.
      This is certainly a new approach to rhinoplasty. Certainly the new generation of equipment is more sophisticated but is it really the debate at a time when only a few surgeons in France use this technique and where even a majority of surgeons make rhinoplasties by closed technique? In any case even with this “first” generation of ultasonic instruments, I get infinitely better precision than with conventional instruments. The results I get are very satisfactory overall and I wish they were even better. I improve with each new intervention precisely by taking into account the advices like yours.
      I invite you to post on our site a video of your own technique. I am sure that would be a great share for everybody.

      Philippe Levan

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