Piezo Ultrasonic Rhinoplasty Cleveland, OH

Ultrasonic rhinoplasty, technically called a piezo rhinoplasty, is a highly precise version of conventional nose reshaping surgery that avoids the use of a hammer and chisel when reshaping the nasal bones and cartilage.

Precision Rhinoplasty with Advanced Piezotome Technique

During surgery, a tool called a piezotome is used to transmit ultrasonic energy, which sculpts and redesigns the nasal bone with minimal swelling or bruising. By avoiding the trauma and soft tissue damage normally associated with rhinoplasty, the procedure provides patients with less downtime and discomfort.

Dr. Jonathan Frankel, a double-board-certified rhinoplasty specialist in Cleveland, utilizes this advanced, cutting-edge technique to deliver nuanced results finely tailored to your unique wishes and specific vision for your appearance.

What Is Ultrasonic (Piezo) Rhinoplasty?

By using an ultrasonic energy-powered piezotome to reshape the nose instead of traditional rhinoplasty tools, Dr. Frankel is able to enhance precision in ways that were never possible before. One of the most common patient goals is the reduction of the dorsal hump on the nasal bridge. The top, firm, immobile portion of the nose is composed of the bone. The structural support of the lower, more mobile portion is composed of cartilage. Ultrasonic rhinoplasty allows for a fine-tuned reduction in the height of the bony portion of the dorsal hump under direct visualization. After removing the bony cap, the nasal bones are no longer continuous, and there is a gap between them (called an “open roof"). In order to bring the nasal bones together and to create a refined narrowing of the nasal bridge, the nasal bones must be repositioned.

Traditionally, instruments called osteotomes (surgical chisels) were used to create the cuts within the bones. Unfortunately, there was a level of unpredictability with the osteotomies (bony cuts), and there were often unexpected/unplanned additional fracture sites. With ultrasonic rhinoplasty, these osteotomies can be made very precisely in a controlled fashion under direct visualization. This is comparable to driving during the night with bright headlights on versus trying to navigate with dim fog lights. The edges of the osteotomy sites can then be gently smoothed with the Piezo, diminishing the risk of any contour irregularities that can occur with more traditional rhinoplasty. Because the ultrasound wavelength of the piezo only affects bone, the underlying tissue (mucosa) is left undisturbed, resulting in less swelling/bruising/discomfort and a quicker recovery.

What Are the Benefits of Ultrasonic (Piezo) Rhinoplasty?

Ultrasonic rhinoplasty not only provides enhanced precision and sculpting for the surgeon but also lessens postoperative bruising and swelling for the patient. The technique lends itself to the much-requested “preservation rhinoplasty”, which focuses more on reshaping rather than removal. The piezotome tool can reshape the nasal bridge without breaking the bone and can also be instrumental in preserving the character of the nasal bridge. With the Piezo System, Dr. Frankel is able to selectively sculpt bone and hard cartilage without affecting the skin, soft cartilage, or mucosa. This gentle approach comes with the following benefits:

Results in less trauma to the face
Helps to minimize post-surgical pain, swelling, bruising, and bleeding
Reduces the risk of a revision procedure
Affords the surgeon a degree of accuracy that is not even possible with intricate rasps
An excellent complement to preservation rhinoplasty techniques

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Who Makes a Good Candidate for the Procedure?

Ultrasonic rhinoplasty is a preferred technique for reducing the dorsal hump and adjusting the nasal bridge bones. It is not suitable for addressing imperfections in the nasal tip or cartilage defects, which are better targeted with suturing and grafting techniques. Another aspect of the surgery to be aware of is that piezo rhinoplasty must be performed with an “open” approach. The technique cannot be used during closed or intranasal rhinoplasty because ultrasonic nose surgery requires direct visualization of the bones during the reshaping process, and the instruments are not long enough to allow for this. Overall, the advantages of the piezo technique outweigh the minor scar that occurs from using an open rhinoplasty approach.

In general, ultrasonic rhinoplasty is recommended for the following patients:

Healthy non-smokers with realistic expectations
Those seeking precision-based narrowing of the nasal bridge
Those looking to reduce a dorsal hump
Those with a crooked nose
Those unhappy with an overly wide or large nose
Those seeking to restore nasal symmetry and balance

How Is the Surgery Performed?

Ultrasonic rhinoplasty is performed under general anesthesia to ensure you are resting peacefully throughout your surgery. The total treatment time is usually around two to three hours. To begin, Dr. Frankel will create a small incision at the base of the nose across the columella (the skin strip that separates the nostrils.) This open approach is necessary so that Dr. Frankel maintains full visualization of the targeted nasal bones at all times. Once the incision is made, the doctor will elevate the nasal skin to access the entire bone structure below. He will then utilize the piezo ultrasound-emitting wand with various tips to refine the dorsal hump, create precision-based cuts while preserving the mucosa, and erode rough surfaces for a balanced and harmonized nasal bridge.

What Can I Expect From the Recovery Process?

Because no traditional chisels, rasps, or hammers are used during surgery, ultrasonic rhinoplasty comes with minimal postoperative downtime or discomfort. Bruising and bleeding are also significantly minimized. Dr. Frankel will apply a nasal splint to keep your bones in position as you heal, with the splint being removed one week post-op. Despite the reduction in trauma that is possible with this cutting-edge approach, patients should still remember that it can take up to one year to see the final result of the surgery. Dr. Frankel will provide you with detailed and customized aftercare instructions and will remain available should any questions or concerns arise during your recovery phase.

Why Choose Dr. Frankel?

Dr. Jonathan Frankel, MD, is an award-winning, double-board-certified rhinoplasty expert in the Cleveland area who is passionate about acquiring the latest in groundbreaking surgical techniques to advance the goals of his patients. He specializes in facial plastic and reconstructive surgery and has an extensive understanding of facial and nasal structure, which informs his precision-oriented approach. Dr. Frankel serves as a clinical instructor at the Case Western Reserve School of Medicine in Otolaryngology-Head and Neck Surgery, where he instructs residents in advanced facial plastic surgery techniques.

He received his Doctor of Medicine degree from Case Western Reserve University School of Medicine, garnering the coveted Medicine Legacy Award. After pursuing a demanding five-year surgical residency in Otolaryngology-Head and Neck Surgery at the University Hospitals Case Medical Center, Dr. Frankel was chosen for an elite fellowship with the American Academy of Facial Plastic and Reconstructive Surgery in Cincinnati, Ohio.