Optimizing Closed Approach Preservation Rhinoplasty by Ultrasonic-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: To evaluate outcomes of piezo-assisted preservation rhinoplasty using specialized instrumentation to enhance visibility, precision, and postoperative recovery in closed rhinoplasty procedures.

Methods: In a cohort of 734 patients undergoing primary rhinoplasty, piezoelectric instruments facilitated closed preservation techniques between May 2021 and April 2023. 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. The SS18 and SS4 inserts by Woodpecker were specifically optimized to enhance cutting efficiency for PPE removal and lateral and transverse osteotomies.

Conclusions: Piezo-assisted rhinoplasty improves precision and reduces trauma, supporting advanced closed preservation rhinoplasty techniques. Despite nowadays all the osteotomies can be done using the ultrasonic piezotome, enhanced instrument design may further refine outcomes, facilitating minimally invasive, aesthetically superior results.