Ultrasonic rhinoplasty, also known as piezo rhinoplasty, is a technique that facilitates precise reshaping of the nose using precision instruments. But what exactly is it? We spoke with Dr. Olivier Gerbault, a plastic surgeon and nasal specialist, and a professor at the International Society of Aesthetic Surgery Institute. He invented this method that is set to revolutionize aesthetic surgery.
Ultrasonic rhinoplasty is trending. On Instagram, the term has hundreds of thousands of mentions. As cosmetic surgery becomes more popular, ultrasonic rhinoplasty has become a global marketing phenomenon. But what is it exactly?
We interviewed Dr. Olivier Gerbault, a plastic surgeon and nasal specialist, a professor at the International Society of Aesthetic Surgery Institute, vice-president of the European Rhinoplasty Society, and president of the International Rhinoplasty Research Society. He developed the instruments and techniques for ultrasonic rhinoplasty in collaboration with the French laboratory ACTEON and named this increasingly popular discipline in aesthetic surgery.
We spoke with him to understand how ultrasonic rhinoplasty is transforming the aesthetic industry by providing more precise, less invasive nose-reshaping techniques.
Where did the concept of ultrasonic rhinoplasty originate? How did it start?
Dr. Olivier Gerbault: “In the early 2010s, I visited top surgeons worldwide who, like me, faced challenges in nasal bone surgery. The nose consists of two parts: the upper part, which is the bony pyramid that causes bumps and asymmetries corrected through bone surgery, and the lower part, which includes the cartilaginous tip and mid-section. Inside the nose, there is also the nasal septum made of cartilage, all covered by the skin.
For over a century, surgeons used traditional instruments like hammers and bone chisels to reduce the width of the nose, correct asymmetries, or remove bumps. They blindly broke the bones with these tools, risking uncontrolled fractures or creating small bone fragments. This often resulted in a nose that could be too concave, have a hole due to a collapsed bone, or show a bump where the bone protruded under the skin, leading to negative aesthetic and sometimes respiratory consequences.
Seeking a safer, more precise solution, I explored piezoelectric surgery used in dentistry. In 2013, I worked with a Japanese laboratory, NSK, specializing in piezo surgery for dentistry. I was interested in their instruments, which operated with these unique cavitation vibrations that specifically target bones without damaging adjacent tissues. I thought this could be beneficial for the nose. Instead of breaking blindly, we could open between the nostrils, lift the skin, bones, and cartilage, place the instrument on the bones, and press a pedal. This could allow us to sculpt, polish, and smooth the bones very progressively under visual control.
So, I asked them to create prototypes for rhinoplasty. I approached Acteon in 2014 to develop specific inserts for rhinoplasty. This collaboration culminated in the launch of ultrasound rhinoplasty instruments and techniques in 2016.”
So, this technology didn’t exist before?
Dr. Olivier Gerbault: “There was literature on its use in dentistry, but nothing existed for rhinoplasty, except for two or three Italian articles. An American team in Philadelphia used a much heavier instrument, which lacked the finesse of piezo technology, and also published a few articles. However, their instrument cost $100,000 at the time and was impractical for surgeons to use.
So indeed, no one in rhinoplasty or ENT surgery knew about piezo technology for rhinoplasty. Ultrasonic rhinoplasty didn’t exist. In 2015, we developed the entire set of instruments and techniques for rhinoplasty with Acteon, and commercialization began in 2016. The patent is on piezo technology, and it’s an Italian patent.”
What are these instruments exactly?
Dr. Olivier Gerbault: “The ultrasound rhinoplasty instruments include a variety of short and long inserts, different saws, drills for bone perforations, and scrapers for precise osteotomies. Short inserts resemble dental tools, while longer instruments, feature extended shafts. The long inserts will be available this year for enhanced surgical access.”
This equipment is very similar to what dentists use.
Dr. Olivier Gerbault: “While piezoelectric technology originated in dentistry, we’ve adapted it for medical use, meeting strict surgical standards. Unlike dental offices, these procedures occur exclusively in operating rooms, ensuring compliance with medical regulations.”
What types of rhinoplasty can this equipment treat?
Dr. Olivier Gerbault: “Ultrasound rhinoplasty caters to both open and closed rhinoplasty techniques. Open rhinoplasty involves a small incision to lift skin, bones, and cartilage. It’s ideal for correcting nasal shape. For closed rhinoplasty, instruments with longer shafts allow precise maneuvers inside the nose without external incisions. These techniques are also applicable to ultrasound septoplasty, which is increasingly sought after but as said before, not yet commercially available.”
What are the advantages of ultrasound rhinoplasty?
Dr. Olivier Gerbault: “Ultrasound rhinoplasty offers several significant benefits over traditional methods. Unlike traditional osteotomes, which involve blunt force trauma, ultrasound rhinoplasty is non-traumatic. The procedure is not performed blindly, which results in fewer complications. The nose is at the center of the face, and a poor rhinoplasty result cannot be hidden. That’s why having precise, controllable instruments is extremely important.
Patients also experience simpler recovery with fewer side effects such as black eyes and bruising, which are common with conventional techniques. They can typically resume their normal activities within a week, without any visible signs of having undergone nasal surgery. The technique also allows for precise sculpting of the nasal bones, enabling correction of the nasal bridge, reduction of width, and reshaping with accuracy.
Besides, for over a century, traditional rhinoplasty prohibited lifting the skin on the sides of the nose due to the risk of destabilizing the nasal structure. Ultrasound rhinoplasty enables safe detachment of the entire nasal pyramid skin, allowing surgeons to see and sculpt the nasal bones precisely without compromising stability. So this is a real revolution.”
Who can utilize this technology?
Dr. Olivier Gerbault: “Ultrasound rhinoplasty is primarily used by plastic surgeons who specialize in cosmetic and reconstructive nasal procedures, ENT Surgeons (Otolaryngologists) who often utilize this technique for both aesthetic and functional improvements, and maxillofacial surgeons who use the technology for intricate facial and nasal surgeries. With the introduction of longer instruments, there are new applications in functional respiratory rhinoplasty, intertwining aesthetic and respiratory improvements.”
What training is required for practitioners?
Dr. Olivier Gerbault: “Practitioners such as plastic surgeons, ENT surgeons, and maxillofacial surgeons need specific training to perform ultrasound rhinoplasty. They must first complete comprehensive theoretical training to understand the principles and techniques of ultrasound rhinoplasty. Hands-on practical training is also crucial. The unique sensation of using the piezo instrument cannot be conveyed through videos or articles alone. Therefore, it is essential to participate in cadaver or specimen workshops to experience and master the technique. Once trained, surgeons can quickly become proficient. Within less than a month, they can start performing ultrasound rhinoplasty effectively. Once trained, practitioners must purchase the necessary equipment, including a unit, handpieces, inserts, and tubing, as there is an irrigation component involved. Inserts need to be replaced every five uses, and the only consumable item is the tubing.”
How long is the operation time?
Dr. Olivier Gerbault: “The operation time is slightly longer. Generally, a primary rhinoplasty, for someone who has never had the procedure before, takes about two to two and a half hours under general anesthesia. Of that time, the portion dedicated to bone surgery takes about five to ten minutes. With the old technique, the bone surgery part took two to three minutes because it is quicker to break and rasp rapidly than to spend time sculpting and incising very precisely. So, the operative time is slightly increased due to the remodeling, but it’s not very significant compared to the overall two to two and a half hours of surgery. The most important thing is that we experience far fewer poor results and complications, with much faster recovery times for the patients.”
Have these techniques been widely adopted?
Dr. Olivier Gerbault: “It’s obvious that using gentle, precise techniques with visual control is preferable to working blindly and breaking bones. However, most surgeons in France still use traditional methods. Adopting new techniques takes time, requires training, and involves the cost of purchasing new equipment. Those who haven’t yet transitioned to Ultrasonic Rhinoplasty are typically general plastic surgeons or general ENT doctors who do one or two rhinoplasties a month. They may not want to change their methods or invest in new equipment for something they perform infrequently. In contrast, I perform 8 to 10 operations a week.
However, I recently came back from a world congress on aesthetic surgery in Colombia. I met a vast majority of surgeons from different countries who now use these new techniques. This means that the technology works and is effective.”
What other applications do you see for this technology in the world of aesthetic surgery?
Dr. Olivier Gerbault: “We already use it for certain types of facelifts. Anytime we need to work on the bones, it can be utilized, for example, in bone suspensions. It can also be used in orbital and eyelid surgery, on the bones of the orbit. Additionally, it’s applied in neurosurgery, maxillofacial surgery, and hand surgery. This technology is developing in many surgical fields.
In my field, what will evolve significantly in rhinoplasty is its application in septoplasty (nasal septum surgery) and surgeries on the turbinates, as well as other functional nasal surgeries. There are many areas where this technology will expand.
My dream is to modify the machine characteristics to use this technology not just on bones but also on cartilage. This requires changing many parameters since cartilage has very different tissue properties, which would allow for cartilage modifications that are currently impossible with piezo technology.”
