Purpose The possibility to obtain precise osteotomies without major soft tissue damage represents a key point in modern approaches to rhinoplasty. In 2007, the authors first described their ultrasonic approach for percutaneous nasal bone osteotomies with minimal periosteal detachment. In this article, they retrospectively analyze the results of their piezo-surgical rhinoplasty technique through their 10-year experience and describe new perspectives of this technique. Patients and Methods A series of 183 patients was retrospectively evaluated. Surgical technique was based on piezoelectric external nasal osteotomies, performed percutaneously, without periosteal detachment. For the last patients, the piezoelectric instrument also was tracked with a navigator (piezo-navigated approach). Data on surgery, hospitalization, ecchymosis, edema, and postoperative complications were evaluated. Results Of the 183 patients, 168 (91.8%) showed grade 0 or 1 edema. Grade 2 edema was noticed in only 15 of 183 patients (8.2%). In 6 of the 183 procedures (3.3%), postoperative complications potentially related to the piezoelectric osteotomy system occurred. Conclusion The piezoelectric external approach can be considered a safe and reliable technique. Preliminary data suggest the possibility of using surgical planning and navigation in positioning the osteotomies in selected subsets of patients.
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