Ultrasound rhinoplasty, also known as piezorhinoplasty, is a technique that facilitates precise reshaping of the nose using precision instruments. But what exactly is it? We spoke with Dr. Olivier Gerbault, plastic surgeon and rhinologist and professor at the International Society of Aesthetic Surgery Institute. He invented this method that is going to revolutionize cosmetic surgery.
Rhinoplasty with ultrasound is in trend. On Instagram, the term has hundreds of thousands of mentions. As cosmetic surgery becomes more popular, ultrasound rhinoplasty has become a global marketing phenomenon. But what exactly is it?
We interviewed Dr. Olivier Gerbault, plastic surgeon and rhinologist, 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 ultrasound rhinoplasty in collaboration with the French laboratory ACTEON and named this increasingly popular branch of cosmetic surgery.
We spoke with him to find out how ultrasound rhinoplasty is transforming the cosmetic industry by providing more precise, less invasive nose reshaping techniques.
Where did the concept of ultrasound rhinoplasty come from? How did it start?
Dr. Olivier Gerbault: “In the early 2010s, I visited leading surgeons around the world 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 bulges and asymmetries that are corrected through bone surgery, and the lower part, which includes the cartilaginous end and middle part. Inside the nose there is also the nasal septum made of cartilage, all covered by skin.
For over a century, surgeons have used traditional tools such as hammers and bone chisels to reduce the width of the nose, correct asymmetries, or remove bumps. They blindly broke bones with these tools, risking uncontrollable fractures or creating small bone fragments. This often resulted in a nose that could be very hollow, have a hole due to damaged bone, or have a bulge where the bone protrudes under the skin, leading to negative aesthetic and sometimes respiratory consequences.
In search of a safer, more accurate solution, I investigated piezoelectric surgery used in dentistry. In 2013, I collaborated with a Japanese laboratory, NSK, specializing in piezosurgery for dentistry. I was interested in their organs, which worked with these unique cavitation vibrations that specifically target bone without damaging adjacent tissue. I thought this could be beneficial for the nose. Instead of breaking blindly, we could open between the nostrils, lift the skin, bone and cartilage, place the instrument on the bone and press a pedal. This could allow us to sculpt, polish and smooth bones very progressively under visual control.
So I asked them to create rhinoplasty prototypes. 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 on rhinoplasty, apart from two or three Italian articles. An American group in Philadelphia used a much heavier instrument, which lacked the finesse of piezo technology, and also published some papers. However, their instrument cost $100,000 at the time and was impractical for surgeons to use.
So really, no one in rhinoplasty or ENT surgery knew about piezo technology for rhinoplasty. There was no ultrasonic rhinoplasty. In 2015, we developed the entire set of instruments and techniques for rhinoplasty with Acteon and commercialization started in 2016. The patent is for piezo technology and is an Italian patent.”
What exactly are these instruments?
Dr Olivier Gerbault: “Ultrasound rhinoplasty instruments include a variety of short and long inserts, different saws, drills for bone drilling and scrapers for precise osteotomies. Short inlays resemble dental instruments, while longer instruments feature extended shafts. Long inserts will be available this year for improved surgical access.”
This equipment is very similar to it dentists use.
Dr. Olivier Gerbault: “While piezoelectric technology originated in dentistry, we have adapted it for medical use, adhering to strict surgical standards. Unlike dental practices, these procedures are performed exclusively in operating rooms, ensuring compliance with medical regulations.”
What kind of rhinoplasty this equipment can do cure;
Dr. Olivier Gerbault: “Ultrasonic rhinoplasty covers both open and closed rhinoplasty techniques. Open rhinoplasty involves a small incision to lift the skin, bone and cartilage. It is ideal for correcting the shape of the nose. For closed rhinoplasty, instruments with longer shafts allow precise maneuvers inside the nose without external incisions. These techniques also apply to ultrasound-assisted diaphragmoplasty, which is increasingly in demand, but as previously mentioned, is not yet commercially available.”
What are the advantages of ultrasound rhinoplasty?
Dr. Olivier Gerbault: “Ultrasonic rhinoplasty offers several significant benefits over traditional methods. Unlike traditional osteotomies, which involve blunt force trauma, ultrasound rhinoplasty is non-traumatic. The procedure is not performed blindly, which results in fewer complications. The nose is in the center of the face and a bad rhinoplasty result cannot be hidden. That’s why it’s extremely important to have accurate, controlled instrumentation.
Patients also experience a simpler recovery with fewer side effects such as black eyes and bruising, which are common with conventional techniques. They can usually resume their normal activities within a week, with no visible signs of having undergone nose surgery. The technique also allows precise sculpting of the nasal bones, allowing the nasal bridge to be corrected, width reduced and reshaped with precision.
After all, 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 allows safe detachment of the entire skin of the nasal pyramid, allowing surgeons to see and sculpt the nasal bones precisely without compromising stability. So this is a real revolution.”
Who can use this technology?
Dr. Olivier Gerbault: “Ultrasonic rhinoplasty is primarily used by plastic surgeons who specialize in cosmetic and reconstructive nose surgery, ENT surgeons (ENTs) who often use this technique for both cosmetic and functional improvements, and maxillofacial surgeons who use the technology for complex facial and nose. With the introduction of longer instruments, there are new applications in functional respiratory rhinoplasty, combining aesthetic and respiratory improvements.”
What training is required for interns?
Dr. Olivier Gerbault: “Professionals such as plastic surgeons, ENT surgeons and maxillofacial surgeons need special training to perform rhinoplasty with ultrasound. They must first complete comprehensive theoretical training to understand the principles and techniques of ultrasound rhinoplasty. Practice is also important. The unique feeling of using the piezo instrument cannot be conveyed through videos or articles alone. Therefore, it is necessary to participate in cadaver or specimen workshops to experience and master the technique. Once trained, surgeons can quickly become proficient. In less than a month, they can effectively begin the ultrasound rhinoplasty. Once trained, practitioners must purchase the necessary equipment, including a unit, handles, inserts and tubing, as an irrigation attachment is involved. The inserts must be replaced every five uses and the only consumable is the tube.”
How long is the operating time?
Dr. Olivier Gerbault: “The operating time is a bit longer. Generally, a primary rhinoplasty, for someone who has never had the procedure before, takes about two and a half hours under general anesthesia. From that time, the portion devoted to bone surgery lasts about five to ten minutes. With the old technique, the bone surgery part took two to three minutes because it’s faster to break and crack quickly than to spend time sculpting and cutting very precisely. Thus, the operative time is slightly increased due to the remodeling, but it is not very significant compared to the total two and a half hours of surgery. Most importantly, we experience far fewer bad outcomes and complications, with much faster recovery times for patients.”
Have these techniques been widely adopted?
Dr. Olivier Gerbault: “It is obvious that using gentle, precise techniques with visual control is preferable to blind work 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 have not yet switched to Ultrasonic Rhinoplasty are usually general plastic surgeons or general ENT doctors who perform one or two rhinoplasty a month. They may not want to change their methods or invest in new equipment for something they rarely perform. Instead, I do 8 to 10 operations a week.
However, I recently returned from a world conference on cosmetic surgery in Colombia. I met an overwhelming majority of surgeons from different countries who are now using 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 cosmetic surgery?
Dr. Olivier Gerbault: “We already use it for certain types of facelifts. Whenever we need to work on bones, it can be used, for example, in bone suspensions. It can also be used in ophthalmoplasty and blepharoplasty, on the orbital bones. In addition, it is applied in neurosurgery, maxillofacial surgery and hand surgery. This technology is being developed in many surgical fields.
In my field, what will significantly evolve in rhinoplasty is its application to septoplasty (nasal septum surgery) and sinus procedures, as well as other functional nasal procedures. There are many areas where this technology will expand.
My dream is to modify the features of the machine to use this technology not only on bone but also on cartilage. This requires changing many parameters, as cartilage has very different tissue properties, which would allow cartilage modifications that are currently impossible with piezo technology.”
