Ultrasonic Rhinoplasty in Londrina: the revolution of nasal piezosurgery
If you are researching rhinoplasty and want to understand the most advanced technology for nose surgery, you need to know about ultrasonic rhinoplasty. With over twenty years of operating on noses and after more than eight thousand plastic surgeries, I can affirm that piezoelectric technology represents one of the most significant advancements I have incorporated into my surgical practice. And the reason is simple: it allows me to sculpt the nasal bones with millimetric precision, without causing damage to the surrounding soft tissues.
The conventional rhinoplasty uses manual osteotomes — instruments that function like small chisels — to fracture and reposition the bones of the nose. Although this technique is well-established and produces good results in the hands of experienced surgeons, it has an inherent limitation: the mechanical force applied to the bone also affects the surrounding blood vessels, nerves, and nasal mucosa. That is why periorbital bruising (the famous "black eyes") and intense swelling are so common after traditional rhinoplasty.
Ultrasonic rhinoplasty elegantly solves this problem. The piezotome — the instrument we use in piezosurgery — generates ultrasonic microvibrations at specific frequencies that selectively cut the bony tissue, without affecting the adjacent soft tissues. It is like having an intelligent scalpel that knows the difference between bone and soft tissue. This transforms the patient experience in the postoperative period and, in many cases, significantly improves the final result.
What is piezoelectric technology in rhinoplasty
Piezosurgery was originally developed for use in dentistry and maxillofacial surgery. The principle is based on the piezoelectric effect: certain ceramics, when subjected to alternating electric current, vibrate at specific ultrasonic frequencies. These vibrations are transmitted to specially designed tips that cut mineralised tissues — such as bone and calcified cartilage — without damaging soft tissues like blood vessels, nerves, mucosa, and skin.
In rhinoplasty, I use tips of different shapes and angles to perform osteotomies (cuts in the bone), shave bony prominences from the nasal dorsum, and sculpt asymmetries with absolute control. The frequency of the ultrasonic microvibrations is calibrated to act only on the bone, which has a different density and rigidity than soft tissues. It is a technology that transforms the act of "breaking the bone" into "sculpting the bone".
Advantages of ultrasonic rhinoplasty over traditional technique
When I compare the results of ultrasonic rhinoplasty with the conventional technique I used for many years, the differences are striking. It is not just a personal preference — international scientific literature supports these advantages with comparative studies published in high-impact journals.
Less bruising and "black eyes"
This is probably the most visible advantage and the one most valued by my patients. In traditional rhinoplasty, osteotomies with manual chisels inevitably rupture blood vessels in the nasal mucosa and periosteum, causing bleeding that accumulates around the eyes. With the piezotome, the vessels are preserved. The result? Many of my patients show no periorbital bruising, and when they do, it is significantly smaller and resolves much faster.
Less postoperative swelling
Swelling after rhinoplasty is largely caused by trauma to the soft tissues during manipulation of the nasal bones. Since piezosurgery preserves these tissues, the swelling is considerably less. This means that the result of the surgery becomes visible sooner — while in the conventional technique many patients wait months to see the final result, in ultrasonic rhinoplasty the evolution is faster and more predictable.
Millimetre precision in bone cuts
Traditional osteotomes produce fractures that do not always follow exactly the desired line. The bone can splinter, create irregularities, or fracture in a "green branch" manner, generating unexpected asymmetries. With the piezotome, each cut is clean, precise, and controlled. I can draw exactly the contour I planned, millimetre by millimetre. This precision is especially important in crooked, asymmetric noses or those that have been previously operated on.
Preservation of the periosteum and better healing
The periosteum is the membrane that covers the bone and contains blood vessels essential for its nutrition and regeneration. In the conventional technique, the periosteum is often damaged by osteotomies. In ultrasonic rhinoplasty, it is preserved, which favours faster, more stable bone healing with a lower risk of palpable irregularities.
Less pain in the postoperative period
Less tissue trauma means less pain. My patients undergoing ultrasonic rhinoplasty consistently report less discomfort in the first few days and require fewer painkillers compared to the traditional technique. This makes recovery more comfortable and less stressful.
In which situations is ultrasonic rhinoplasty especially indicated
Although piezoelectric technology can be used in virtually any rhinoplasty involving work on the nasal bones, there are situations where it becomes particularly valuable:
Reduction of the bony hump (nasal hump)
The hump or bump on the bridge of the nose is one of the most common complaints from patients seeking rhinoplasty. In the traditional technique, the hump is removed with rasps or osteotomes, and then the nasal bones are fractured to close the "open roof" that forms. With the piezotome, I can shave the bony hump with absolute precision and perform the lateral osteotomies in a controlled manner. The result is a smoother and more symmetrical bridge, with less risk of irregularities.
Crooked and asymmetric noses
Correcting a crooked nose is one of the greatest challenges of rhinoplasty. Bony asymmetry requires asymmetric osteotomies, cuts at different angles on each side. With manual instruments, this asymmetry is difficult to control. With the piezotome, I can plan and execute each cut accurately, significantly increasing the predictability of the result. For complex cases of nasal deviation, I often combine ultrasonic rhinoplasty with rhinoseptoplasty to simultaneously address the septal deviation.
Preservation rhinoplasty
One of the most important trends in modern rhinoplasty is the preservation approach, which seeks to keep the dorsal structures intact rather than removing and reconstructing them. Ultrasonic rhinoplasty is the ideal tool for this philosophy, as it allows for precise osteotomies that "lower" the nasal bridge without destroying the natural anatomy. The result is a nose that looks naturally beautiful, not operated on.
Secondary and revision rhinoplasty
Patients who have previously had nose surgery and are not satisfied with the result — or have developed complications — present altered anatomy with internal scars and bones that have already been manipulated. The precision of piezosurgery is crucial in these cases, as it allows for safe and controlled work on previously operated tissues. If you are considering a secondary rhinoplasty, the ultrasonic approach can make a significant difference in the outcome.
Male rhinoplasty
Male rhinoplasty requires a specific approach, preserving traits that confer masculinity to the face while correcting imperfections. Men tend to have thicker and more resilient nasal bones, making the precision of the piezotome even more valuable for sculpting a straight and proportional bridge without feminising the nose.
Ethnic rhinoplasty
Each ethnicity has its own nasal characteristics that must be respected and harmonised. In ethnic rhinoplasty, the piezotome allows for subtle bony adjustments that enhance facial harmony without erasing the patient's identity. Millimetre precision is essential for results that are both beautiful and natural.
How ultrasonic rhinoplasty works in practice
I understand that the technology may seem abstract when described in technical terms. Let me explain exactly how ultrasonic rhinoplasty happens in practice, from planning to execution.
Surgical planning
Every exceptional result begins with meticulous planning. During the consultation, I thoroughly examine the bony and cartilaginous structure of your nose, the thickness of the skin, the quality of the mucosa, and the relationship of the nose with other facial structures. I use standardised photographs and, in many cases, digital simulations so that you can visualise the expected result before entering the operating room.
It is during planning that I decide which tips of the piezotome will be used, which osteotomies will be necessary, and what the ideal sequence of steps will be. Each nose is unique, and the planning of ultrasonic rhinoplasty must be individualised.
The surgical procedure
Ultrasonic rhinoplasty is performed under general anaesthesia, in a properly equipped surgical centre. The surgery lasts between two and three hours, depending on the complexity of the case and any additional procedures that may be associated.
I generally use the open approach (structured rhinoplasty), with a small incision in the columella — the column of tissue between the nostrils. This gives me direct visibility of all structures and allows me to use the piezotome with maximum precision. After working on the cartilages — which is done with traditional rhinoplasty instruments — I reach the bony stage.
With the piezotome in hand, I begin the removal of the bony hump (when present) with gentle and controlled movements. The ultrasonic microvibrations gradually wear down the bone, like a sculptor chiselling a precious stone. Next, I perform the lateral osteotomies to narrow or reposition the nasal bones. Each cut is clean, precise, and follows exactly the line I traced in the planning.
What happens to the soft tissues
This is the crucial point of the technology. While the piezotome efficiently cuts the bone, the blood vessels, nerves, and nasal mucosa that are in direct contact with the tips are simply not affected. They "sway" with the ultrasonic vibrations but are not cut. It is as if the tips are invisible to the soft tissues. This explains why the postoperative period is so much calmer.
Ultrasonic rhinoplasty and structured rhinoplasty: complementary techniques
It is important to clarify a point that generates confusion: ultrasonic rhinoplasty is not a separate or opposing technique to structured rhinoplasty. In fact, they are perfectly complementary. Structured rhinoplasty is the surgical philosophy — the concept that we must build a strong and stable structure using cartilage grafts to support and shape the nose. Ultrasonic rhinoplasty is the technology — the instrument we use for the bony part of the procedure.
In my practice, I combine both approaches. I use the principles of structured rhinoplasty to work on the cartilages (nasal tip, upper and lower lateral cartilages) and piezoelectric technology to work on the nasal bones. This combination gives me the best of both worlds: a strong and well-defined cartilaginous structure supporting a precisely sculpted bony framework.
Cartilage grafts in ultrasonic rhinoplasty
The use of cartilage grafts remains fundamental, even with piezoelectric technology. The cartilage from the nasal septum is my main source of graft. When necessary, I can also use cartilage from the ear (auricular concha) or, in complex secondary rhinoplasties, costal cartilage.
These grafts are used to refine the nasal tip, strengthen the nasal valves (improving breathing), correct retractions, and build structural support. The precision of the bony cuts with the piezotome complements this cartilaginous reconstruction, ensuring that the bony skeleton of the nose is perfectly aligned with the new cartilaginous structure.
The importance of the nose as a functional and aesthetic unit
I never lose sight of the fact that the nose is not just an aesthetic structure — it is a fundamental organ for breathing. Every rhinoplasty I perform, whether with ultrasonic technology or not, respects and improves respiratory function. If there is a septal deviation or turbinate hypertrophy, these issues are corrected in the same surgical time. Beauty and function go hand in hand.
Recovery from ultrasonic rhinoplasty: what to expect
The recovery is one of the areas where ultrasonic rhinoplasty stands out compared to the conventional technique. Although each patient is unique and the speed of recovery varies, the general patterns I observe in my practice are consistent.
First 48 hours
You will leave the surgery with a splint on the nasal bridge and, in most cases, without nasal packing — I use internal hemostatic stitches that eliminate the need for that uncomfortable packing that frightens patients. There will be some swelling, mainly concentrated in the nose and periorbital region. However, unlike the traditional technique, it is common for "black eyes" to be minimal or even non-existent.
First week
The swelling peaks between the second and third day and begins to decrease progressively. You will feel your nose "congested," as if you have a strong cold, but the pain is usually mild and well controlled with simple analgesics. Avoid bending your head, physical exertion, and sun exposure. On the seventh day, I usually remove the nasal splint and the external stitches.
Second to fourth week
With the splint removed, you will already have a good idea of the result, although the nose will still be swollen. Most patients return to work and social activities between seven and ten days — significantly earlier than with conventional rhinoplasty, where this timeframe is usually two to three weeks. Makeup can be used carefully to camouflage any residual bruising.
One to six months
The residual swelling gradually decreases. The nasal tip is the last area to completely de-swell, especially in patients with thick skin. It is during this period that the result refines and the nose acquires its definitive shape.
Final result
The definitive result of ultrasonic rhinoplasty is usually visible between six months and a year, depending on skin thickness and case complexity. The advantage of the piezotome is that, as there is less tissue trauma, the process of resolving the swelling tends to be faster and more predictable.
Ultrasonic rhinoplasty and the potato nose
A frequent question from my patients is whether ultrasonic rhinoplasty resolves the so-called potato nose. The answer requires nuance: the potato nose is primarily caused by bulky nasal tip cartilages and/or thick skin, not by the bony structure. Therefore, correcting the potato nose fundamentally depends on working on the cartilages — refining, suturing, and, when necessary, structural grafts.
However, many patients with a potato nose also have a wide or humped bridge, and it is precisely at this stage that ultrasonic technology comes into play. The combination of cartilaginous refinement of the tip with the precise narrowing of the bony bridge by the piezotome delivers a harmonious and proportional result that would be more difficult to achieve with traditional instruments.
The harmony between tip and bridge
One of the fundamental principles I follow in all rhinoplasties is that the nose needs to be worked on as a unit. It is pointless to narrow the tip and leave the bridge wide, or to narrow the bridge and maintain a bulbous tip. Ultrasonic rhinoplasty allows me to sculpt the bony bridge with the same delicacy with which I work the cartilages, ensuring smooth and natural transitions between all the nasal subunits.
Who is a candidate for ultrasonic rhinoplasty
Ultrasonic rhinoplasty is indicated for patients who require work on the nasal bones as part of their rhinoplasty. In practice, this includes the vast majority of patients, as there are few cases where the surgery is restricted solely to cartilages and soft tissues.
Ideal candidates
Patients with bony hump: the bump on the nasal bridge is the classic indication, where the piezotome offers controlled scraping and precise osteotomies.
Patients with crooked nose: bony asymmetry is corrected with asymmetric osteotomies that the piezotome executes with millimetric accuracy.
Patients with wide bridge: narrowing the nasal bridge requires lateral osteotomies that, with ultrasonic technology, are cleaner and more predictable.
Patients undergoing secondary rhinoplasty: previously operated and healed tissues require maximum precision to avoid additional complications.
Patients concerned about recovery: those with a tight professional or social schedule benefit enormously from the faster recovery provided by piezosurgery.
Patients with thin skin: any bony irregularity is more visible in noses with thin skin, making the precision of the piezotome even more valuable.
Evaluation at the consultation
During the in-person consultation, I examine each patient individually to determine if ultrasonic rhinoplasty is the best approach for their case. I analyse the thickness of the nasal bones, the relationship between the bony and cartilaginous structures, the quality of the skin, and, of course, their goals and expectations. In some rare cases, when the work is exclusively on soft tissues and cartilages, the piezotome may not be necessary — but in these situations, I clearly inform during the consultation.
Contraindications
The contraindications for ultrasonic rhinoplasty are the same as for any rhinoplasty: decompensated systemic diseases, uncontrolled coagulation disorders, unrealistic expectations, and psychological issues that contraindicate aesthetic surgery. The piezoelectric technology itself does not add specific contraindications.
The consultation for ultrasonic rhinoplasty in Londrina
The consultation is the most important moment of the entire process. I dedicate time to understand not only what you want to change about your nose but why you want to change it. I listen to your complaints, examine your nasal and facial anatomy in detail, and explain transparently what is possible to achieve.
What I evaluate in the consultation
Nasal bony structure: width, symmetry, presence of hump, deviations of the bony bridge.
Nasal cartilages: shape and position of the upper and lower lateral cartilages, projection and definition of the tip.
Nasal septum: presence of deviation, availability of cartilage for grafts.
Nasal skin: thickness, elasticity, quality — a determining factor in the final result.
Smoking should be stopped for the same period, as nicotine compromises blood circulation and can hinder healing.
Procedures that can be combined with ultrasonic rhinoplasty
Ultrasonic rhinoplasty can be associated with other procedures in the same surgical time, optimising the overall aesthetic result and avoiding the need for a second surgery:
Mentoplasty and genioplasty
The relationship between the nose and chin is fundamental for the harmony of the facial profile. A receded chin can make the nose appear larger than it actually is. Mentoplasty (with silicone implant) or genioplasty (bony advancement of the chin) performed in the same surgical time as rhinoplasty provide a balanced and harmonious profile. This combination is one of the most powerful in facial plastic surgery.
Septoplasty
If you have a deviated septum causing respiratory obstruction, the correction is performed during the rhinoplasty itself. Rhinoseptoplasty combines the aesthetic benefits of rhinoplasty with the functional improvement of breathing. It is the most complete surgery for those who want a beautiful nose that functions well.
Turbinectomy
Nasal turbinate hypertrophy (also called turbinates) is a common cause of nasal obstruction. When present, I perform turbinate reduction during rhinoplasty, enlarging the airways and significantly improving breathing.
Blepharoplasty
The combination of rhinoplasty with eyelid surgery can completely transform the middle third of the face. Excess skin on the upper eyelids or fat bags on the lower ones can be corrected in the same procedure, providing harmonious rejuvenation.
My training and experience in rhinoplasty
I graduated from the State University of Londrina and had the privilege of being a student of Professor Ivo Pitanguy, the greatest name in Brazilian plastic surgery and one of the most respected in the world. With him, I learned not only surgical techniques but a philosophy of respect for the patient and the pursuit of excellence that I carry with me to this day.
Over more than twenty years of practice, I have performed over eight thousand plastic surgeries. Rhinoplasty has always been one of the surgeries that fascinated me the most — due to the technical complexity, the precision required, and the transformative impact it has on patients' self-esteem. I am a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS), and I regularly participate in national and international congresses, keeping myself updated with the advances in the specialty.
The incorporation of piezoelectric technology into my practice was a natural step in the pursuit of ever better results. After specific training and immersion in the scientific literature on nasal piezosurgery, I incorporated the piezotome into my surgical arsenal, and the results confirmed what science had already indicated: more precision, less trauma, and faster recovery for patients.
Why trust me for your ultrasonic rhinoplasty
Rhinoplasty is considered by many surgeons to be the most difficult surgery in plastic surgery. Every millimetre makes a difference, and the nose is at the centre of the face — there is no way to hide an unsatisfactory result. My accumulated experience of over two decades, combined with state-of-the-art piezoelectric technology, offers the ideal combination for those seeking a natural, precise, and lasting result.
I do not promise perfection — it does not exist. I promise honesty, refined technique, and total dedication to your result. If during the consultation I perceive that your expectations are not compatible with what the surgery can offer, I will say this clearly. I prefer to lose a surgery than to create an expectation that I cannot fulfil.
Frequently asked questions about ultrasonic rhinoplasty
What is ultrasonic rhinoplasty?
It is a rhinoplasty that uses piezoelectric technology (piezotome) to perform cuts and sculpt the nasal bones. The instrument generates ultrasonic microvibrations that cut the bone with millimetric precision without damaging the surrounding soft tissues — vessels, nerves, and mucosa. This results in less bruising, less swelling, and faster recovery.
What is the difference between ultrasonic rhinoplasty and conventional rhinoplasty?
In conventional rhinoplasty, the nasal bones are manipulated with manual osteotomes (chisels), which apply mechanical force and inevitably cause trauma to the adjacent soft tissues. In ultrasonic rhinoplasty, the piezotome selectively cuts the bone without affecting soft tissues, resulting in cleaner cuts, less bleeding, less periorbital bruising, and a more comfortable recovery.
Does ultrasonic rhinoplasty hurt more or less than conventional rhinoplasty?
Significantly less. As there is less trauma to the soft tissues, postoperative pain is reduced. Most of my patients manage discomfort with simple analgesics and report that the experience was much more peaceful than they expected.
How long does recovery from ultrasonic rhinoplasty take?
The nasal splint is removed in about seven days. Most patients return to work and social activities within seven to ten days. Residual swelling decreases progressively over weeks to months, and the definitive result is visible between six months and a year. Recovery is consistently faster than with the conventional technique.
Does ultrasonic rhinoplasty leave a scar?
The scar from ultrasonic rhinoplasty is the same as that of conventional rhinoplasty — it depends on the approach used. In open rhinoplasty, there is a small incision in the columella (between the nostrils) that becomes practically invisible in a few weeks. In the closed approach, all incisions are internal, with no visible scars.
Does ultrasonic rhinoplasty correct breathing problems?
Yes. Ultrasonic rhinoplasty can be combined with the correction of a deviated septum (septoplasty) and reduction of turbinates in the same procedure. The aesthetic and functional improvement of the nose is achieved simultaneously.
How much does ultrasonic rhinoplasty cost?
The cost varies according to the complexity of the case, associated procedures, and other individual factors. Ultrasonic rhinoplasty may have a slightly higher cost than conventional rhinoplasty due to the use of piezoelectric technology, but the benefits in precision and recovery fully justify the investment. The exact amount is provided after the in-person consultation, where I can assess your case individually.
Is ultrasonic rhinoplasty suitable for any type of nose?
The piezoelectric technology is indicated whenever there is a need to work on the nasal bones, which includes the vast majority of rhinoplasty cases. For cases where the work is exclusively on cartilages and soft tissues (such as isolated refinement of the nasal tip), the piezotome may not be necessary. During the consultation, I evaluate each case and indicate the best approach.
Can I have ultrasonic rhinoplasty if I have had nose surgery before?
Yes, and in these cases, the technology is especially valuable. Secondary or revisional rhinoplasty is more complex than primary rhinoplasty, as the tissues have already been manipulated and present internal scars. The precision of the piezotome allows for safe and controlled work on these delicate tissues, increasing the chances of a good result.
Can ultrasonic rhinoplasty be combined with other procedures?
Yes. The most common associations are with mentoplasty (chin implant), genioplasty (bone advancement of the chin), septoplasty, turbinectomy, and blepharoplasty. The combination is individually planned to optimise the overall result and minimise the number of surgical procedures.
Is the anaesthesia for ultrasonic rhinoplasty general?
Yes. I perform ultrasonic rhinoplasty under general anaesthesia, in a properly equipped surgical centre with a dedicated anaesthesia team. General anaesthesia ensures total comfort during the procedure and allows me to work with the concentration and precision necessary for the best result.
Do I need to use nasal packing after ultrasonic rhinoplasty?
In the vast majority of cases, no. I use internal hemostatic stitches that control bleeding without the need for traditional nasal packing. This is one of the advantages that my patients value the most, as packing is often described as the most uncomfortable part of rhinoplasty recovery.
Is ultrasonic rhinoplasty permanent?
Yes. The results of ultrasonic rhinoplasty are definitive. Once the nasal bones are remodelled and heal in their new position, they remain so permanently. The nose will continue to age naturally over the years, like any structure in the body, but the changes made during surgery are lasting.
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