Secondary Logo

Journal Logo

Use of the Ultrasonic Bone Aspirator for Lateral Osteotomies in Rhinoplasty

Robiony, Massimo M.D., F.E.B.O.M.F.S.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 921e–922e
doi: 10.1097/PRS.0000000000001188

University Hospital of Udine, Department of Medical and Biological Sciences, Ple Kolbe 4-33100, Udine, Italy,

Back to Top | Article Outline


The article entitled “Use of the Ultrasonic Bone Aspirator for Lateral Osteotomies in Rhinoplasty” by Cochran and Roostaeian1 claims that the ideal osteotomy technique delivers precise control, consistent results, low complication rates, and minimal postoperative sequelae. The technique offers a new approach to nasal osteotomies in rhinoplasty using ultrasonic vibrations. This was first described by us2,3; however, it is not mentioned by Cochran and Roostaeian, who falsely claim that “no previous studies have examined the role of the ultrasonic bone aspirator in performing lateral osteotomies in rhinoplasty.”

In 2007,2,3 we published a new nasal osteotomy technique using piezoelectric ultrasonic vibrations instead of the standard chisel to minimize postoperative sequelae. Cochran and Roostaeian report only five consecutive cases (August to October of 2011) in a retrospective analysis of preoperative and postoperative photographs. Some technical aspects, such as insert tip thickness, are omitted. They suggest creating a subperiosteal tunnel along the planned lateral osteotomy path to the intercanthal line anterior to the lacrimal crest. Their results are as follows: “Intraoperatively, we noted minimal mechanical force required to make the osteotomies and no bleeding following the osteotomy. No patients had visible or palpable stepoff deformities, irregularities, or asymmetries. There were no open-roof or inverted-V deformities, or revision procedures. All patients had minimal pain and minimal-to-no bruising at 5 to 7 days postoperatively. No patients reported worsening of their nasal breathing.” They conclude that ultrasonic bone aspiration is feasible for lateral osteotomies in rhinoplasty.

Our ultrasound experience for osteotomies in rhinoplasty started with a 2002 cadaver study in which a rapid linear cut, minimal or absent internal mucosal damage, minimal periosteal detachment, and technical feasibility were noted (Fig. 1). The osteotomy was continuous rather than perforating. Our technique has been performed in 175 patients with a percutaneous approach (Fig. 2) without a subperiosteal tunnel using an ultrasonic piezosurgical instrument to perform sharp osteotomies (Mectron Medical Technology, Carrasco, Italy). It allows efficient cutting of mineralized tissues with minimal soft-tissue trauma. The insert tip is 0.5 or 0.3 mm thick, allowing an effective cut that preserves osteotomized surface integrity and avoids overheating of mineralized tissue. Previous histologic examination of the cut surfaces of bony segments confirmed the lack of coagulative necrosis and identified live osteocytes.4

Fig. 1

Fig. 1

Fig. 2

Fig. 2

In our study, all patients were evaluated for ecchymosis, bleeding, edema, and scarring immediately and at 1 and 2 weeks postoperatively. Reduction of bleeding during surgery, minor edema, periorbital ecchymosis, and no visible scarring were noted immediately postoperatively. Considerable reduction of trauma, postoperative edema, and ecchymosis was noted. These results were confirmed by previous histologic findings that support the relationship between minor surgical trauma and better soft and hard tissue behavior during healing.

We felt obliged to point out the above to ensure correct attribution of the paternity of the first application of ultrasound in rhinoplasty. Above all, we wanted to report that the important details and advantages of the use of ultrasound osteotomies in rhinoplasty are superimposable. Therefore, the literature should be evaluated to glean the truth regarding use of ultrasound for osteotomies in rhinoplasty.

Back to Top | Article Outline


The author has no financial interest to declare in relation to the content of this communication.

Massimo Robiony, M.D., F.E.B.O.M.F.S.

University Hospital of Udine

Department of Medical and Biological Sciences

Ple Kolbe 4-33100

Udine, Italy

Back to Top | Article Outline


1. Cochran CS, Roostaeian J.. Use of the ultrasonic bone aspirator for lateral osteotomies in rhinoplasty. Plast Reconstr Surg. 2013;132:1430–1433
2. Robiony M, Polini F, Costa F, Toro C, Politi M.. Ultrasound piezoelectric vibrations to perform osteotomies in rhinoplasty. J Oral Maxillofac Surg. 2007;65:1035–1038
3. Robiony M, Toro C, Costa F, Sembronio S, Polini F, Politi M.. Piezosurgery: A new method for osteotomies in rhinoplasty. J Craniofac Surg. 2007;18:1098–1100
4. Robiony M, Polini F, Costa F, Vercellotti T, Politi M.. Piezoelectric bone cutting in multiple piece maxillary osteotomy. J Oral Maxillofac Surg. 2004;62:759–761
Back to Top | Article Outline


Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2015American Society of Plastic Surgeons