Ultrasonic (piezoelectric) rhinoplasty disadvantages

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.

All cosmetic surgery involves risks and individual results vary. Cosmetic surgery is a serious decision. Decisions about whether to proceed should be made after careful consideration and following at least two consultations with a qualified medical practitioner.

Ultrasonic (piezoelectric) rhinoplasty uses high-frequency ultrasonic instruments to perform osteotomies and bone reshaping in the nose. The technique was widely promoted from approximately 2018 onward on the basis that it offered greater precision and reduced trauma to surrounding soft tissue compared with conventional chisels and osteotomes. By 2024, however, clinical experience had led many experienced rhinoplasty surgeons to reassess its role.

All surgery carries risks — read the full rhinoplasty risks page →

Limitations and Disadvantages

More swelling, not less

Because the ultrasonic handpiece requires a wider dissection pocket to allow instrument passage, patients undergoing ultrasonic rhinoplasty often experience greater facial oedema and bruising than those undergoing preservation rhinoplasty techniques — which require less tissue elevation and work in anatomical dissection planes.

Specialised training required

The technique requires specific training and a learning curve. Not all surgeons who advertise the procedure have equivalent levels of experience with it.

Higher cost

The specialised equipment is costly, and this is typically reflected in the surgical fee. The additional cost is not necessarily associated with better outcomes.

Limited applicability

Ultrasonic instruments are primarily useful for the bony dorsum. They do not address the cartilaginous component of the nose, and their advantages over conventional instruments are most pronounced in specific anatomical contexts.

Longer operating time

The meticulous nature of the technique can extend operating time in some cases.

Equipment dependence

Dependence on specialised equipment introduces a risk of equipment malfunction during surgery.

Dr Roth’s View

Dr Roth does not routinely use ultrasonic rhinoplasty instruments. His view — consistent with the direction of the field as of 2024 — is that preservation rhinoplasty techniques performed in appropriate subperichondrial and subperiosteal dissection planes produce at least equivalent results without the additional soft tissue disruption required for ultrasonic instrument passage. Patients are welcome to discuss the evidence around specific techniques at consultation.

Dr Roth’s Clinical Perspective

Ultrasonic rhinoplasty is a tool, not a technique — it addresses the bony component of rhinoplasty with more precision and less trauma than traditional osteotomes, but the surgical goals and the cartilage work are unchanged. I use piezoelectric instruments selectively where precise bony work is required, particularly in preservation rhinoplasty where the dorsum is being mobilised rather than excised. The marketing around ultrasonic rhinoplasty as a transformative advance overstates what is essentially an improvement in one instrument category. The result depends on the surgical plan and the cartilage management — the osteotomy technique is a component, not the determinant.

— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS

Dr Jason Roth — Specialist Otolaryngologist Sydney

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Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.

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(02) 9982 3439

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.

Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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