Optimizing Closed-Approach Preservation Rhinoplasty by Ultrasonic Piezo-assisted Techniques for Enhanced Precision.

[BACKGROUND] Preservation rhinoplasty, particularly dorsal preservation, has gained prominence with the advent of piezoelectric instruments, which minimize trauma and enhance precision in bone reshaping. This approach presents unique challenges, especially in closed techniques, where spatial limitations complicate the use of piezotomes.

[OBJECTIVES] The aim of this study was to evaluate outcomes of piezo-assisted preservation rhinoplasty performed with specialized instrumentation to enhance visibility, precision, and postoperative recovery in closed rhinoplasty procedures.

[METHODS] In a cohort of 734 patients undergoing primary rhinoplasty between May 2021 and April 2023, piezoelectric instruments facilitated closed preservation techniques. Cases were documented with a focus on instrument adaptation, bone reshaping precision, and the mitigation of postoperative complications.

[RESULTS] A 6% revision rate was observed, predominantly for dorsal contour adjustments, with minimal intraoperative bleeding, swelling, and postoperative pain, demonstrating the effectiveness of piezoelectric assistance. Woodpecker (Guilin, China) SS18 and SS4 inserts were specifically optimized to enhance cutting efficiency for removal of the perpendicular plate of the ethmoid, and for lateral and transverse osteotomies.

[CONCLUSIONS] Piezo-assisted rhinoplasty improves precision and reduces trauma, supporting advanced closed preservation rhinoplasty techniques. Although all osteotomies can now be performed with ultrasonic piezotomes, enhanced instrument design may further refine outcomes, facilitating minimally invasive, aesthetically superior results.