Ultrasonic rhinoplasty in Switzerland: what piezosurgery changes

Ultrasonic rhinoplasty, also called piezo rhinoplasty, refers to a rhinoplasty in which the surgeon reshapes the bony part of the nose using an instrument that vibrates at very high frequency, instead of traditional chisels, rasps and osteotomes. This technology, which comes from dental and maxillofacial surgery, allows bone to be sculpted with great precision while sparing the neighbouring soft tissues. This page focuses on what the instrument really changes: its principle, the steps it allows, its proven or supposed advantages, its limitations, how a procedure is performed, recovery, relative price and where in Switzerland this equipment is available. For the basics of nose surgery, see our general page on rhinoplasty in Switzerland.

Ultrasonic instruments only concern the bony part of the nose: the bony hump, the width of the root and deviation of the nasal bones. The cartilage of the tip and the middle third is always worked on with conventional instruments. The instrument cuts bone but largely spares blood vessels, nerves and mucous membrane, which can reduce bruising and improve precision. It generally requires wider undermining of the skin of the nose, often through the open approach, and specific equipment. The relative budget, by city, is on our page on ultrasonic rhinoplasty prices in Switzerland.

The heart of the device is a piezoelectric crystal or ceramic, a material that expands and contracts very rapidly when it receives an alternating electric current. These micro-movements are transmitted to an interchangeable metal tip, called an insert, which vibrates at an ultrasonic frequency of several tens of thousands of cycles per second, with an amplitude of only a few tens of micrometres.

Selective cutting

At this frequency and amplitude, the insert effectively breaks down mineralised tissues such as bone, which are rigid and cannot absorb the vibration. Soft, elastic tissues such as blood vessels, nerves, mucous membrane or skin move with the vibration and are largely spared as long as contact remains brief and controlled. It is this selectivity that makes the technique valuable in an area as narrow and well supplied with blood vessels as the nose.

Inserts adapted to each step

The surgeon has several inserts: rasps of different coarseness for lowering and smoothing a hump, very fine saws for osteotomies, and rounded tips for sculpting. They change them during the procedure according to the step being performed.

Continuous irrigation

The vibration produces heat. A sterile fluid is therefore sprayed continuously onto the insert to cool the bone and remove debris. This rinsing also improves visibility of the operating field.

A procedure without percussion

With conventional instruments, the surgeon strikes an osteotome with a small mallet to fracture the bones in a controlled way. Ultrasonic instruments replace this percussion with gradual, smooth cutting, allowing the desired line to be followed exactly and irregular fractures to be avoided.

It is important not to overestimate the contribution of the technology. An ultrasonic rhinoplasty remains a rhinoplasty: the result depends above all on the diagnosis, planning and work on the cartilage, which the instrument does not perform.

What can change

The precision of the bone work, with clean, symmetrical cutting lines; the possibility of sculpting the hump and bony walls under direct vision, rather than fracturing them; less trauma to soft tissues, which could reduce bruising and eyelid swelling in some patients; better control of the position of the mobilised bones.

What does not change

The shape of the tip, which depends on the alar cartilages; the middle third and the nasal valve; the septum, which is still operated on with the usual techniques; swelling of the tip, which follows its own timetable; the need for an experienced surgeon.

What may be less favourable

To see and work on the bone properly, the surgeon often lifts the skin and periosteum over a wider area than with conventional osteotomies, generally through the open approach. This undermining can prolong swelling of the bridge of the nose in some patients. The procedure also often takes a little longer.

What the studies say

Several comparative studies have reported, after ultrasonic rhinoplasty, less bruising around the eyes and less marked periorbital swelling in the first few days, as well as smoother bony contours. Other studies show no significant difference in the final aesthetic result at one year. The available data therefore suggest a benefit mainly for the immediate after-effects and the precision of the bone work, rather than a transformation of the final result. The quality of the studies remains variable, and the surgeon's experience counts as much as the tool.

The value of ultrasonic instruments increases with the amount of work on the bone. For a rhinoplasty involving only the tip, they add nothing.

Humps with a large bony component

When the hump is mainly bony, high up near the root, the ultrasonic rasp allows it to be lowered gradually by sculpting the walls, rather than removing it in one piece and then closing the roof with fractures.

Noses that are wide at the root

To narrow the bony part, ultrasonic osteotomies follow a precise line without splintering, which makes symmetrical narrowing easier.

Bony deviations

A nose whose bones are deviated, often after an injury, requires precise realignment. Controlled cutting makes it easier to mobilise and reposition the fragments.

Thick or asymmetrical bones

In patients with thick nasal bones, gradual sculpting avoids unpredictable fractures. Asymmetry of the bony walls can be corrected with finer shaping.

Some revisions

In a secondary rhinoplasty with bony irregularities, the fineness of the inserts allows precise smoothing or reshaping.

Preservation rhinoplasties

In some variants of preservation, lowering the bridge involves removing a strip of bone at the base of the nasal pyramid; ultrasonic instruments are often used for these cuts.

Situations where the benefit is limited

A rhinoplasty limited to the tip, correction of the nostrils, septoplasty alone or a mainly cartilaginous hump do not necessarily justify the use of ultrasonic instruments. In patients with very thick skin, the gain in bony precision is less visible, as the skin hides fine detail.

To use ultrasonic inserts while seeing the bone precisely, the surgeon must expose the bony pyramid. They lift the skin, then the periosteum, the thin membrane covering the bone, over the whole area to be worked on. Most surgeons who use ultrasonic instruments extensively therefore go through the open approach, with the small incision on the columella.

Some perform limited ultrasonic steps through the closed approach, particularly osteotomies, with suitable inserts. The choice depends on the extent of the bone work and the surgeon's habits. This wider undermining has a downside: the bridge of the nose may stay a little more swollen during the first few weeks. On the other hand, the instrument's preservation of blood vessels and soft tissues tends to limit bruising. The balance depends on each patient and each procedure.

The concept of "rhinosculpture"

Proponents of the technique sometimes speak of sculpting the nose: instead of breaking and then repositioning, the surgeon shapes the bone in small touches, checking symmetry and profile at each stage. This approach takes time and familiarity with the instrument, but it allows very smooth bony contours, which are particularly valuable in patients with thin skin, where the slightest irregularity would show.

Planning

During the consultation, the surgeon assesses the bony and cartilaginous share of the hump, the width of the root, any deviation of the bones, skin thickness and respiratory function. They explain what ultrasonic instruments will bring in your case, and what will be done conventionally.

Anaesthesia

The procedure takes place under general anaesthesia. The anaesthetist keeps blood pressure moderate to limit bleeding.

Exposing the bone

The surgeon makes the incisions, often through the open approach, then lifts the skin and periosteum to expose the bony pyramid.

Bone work

They use the inserts in turn: a rasp to lower or smooth the hump, a fine saw for lateral and sometimes medial osteotomies, and a finishing tip. Irrigation continuously cools the bone. The mobilised bone fragments are repositioned precisely.

Cartilage work and the septum

The surgeon then treats the septum, the middle third and the tip with the usual techniques: sutures, grafts, measured resections.

Closure

They replace the periosteum and skin, close the incisions, place internal splints if necessary and the external splint. The procedure generally takes a little longer than a comparable conventional rhinoplasty, often two and a half to four hours.

Recovery follows the general pattern of rhinoplasty, with a few possible differences.

The advice is the same as for any rhinoplasty: head raised, cold in the first few days, no hard nose-blowing, no glasses resting on the bridge of the nose for several weeks, protection from impacts and sun. Having less bruising does not mean the bones consolidate faster: the same precautions apply.

Risks common to any rhinoplasty

Imperfect aesthetic result, breathing problems, bleeding, infection, septal perforation, temporary changes in sense of smell, graft complications. They are detailed on our general page on rhinoplasty.

Overheating

The vibration produces heat. Without sufficient irrigation or with prolonged contact, thermal injury to the bone or neighbouring tissues is theoretically possible. Continuous irrigation and mastery of the instrument make this risk very low.

Soft tissue injury

Selectivity is not absolute: firm, prolonged contact can injure the mucous membrane or skin. The surgeon's experience is decisive.

Prolonged swelling of the bridge

More extensive undermining can prolong swelling of the bridge of the nose by a few weeks.

Operating time

A slightly longer procedure prolongs anaesthesia; in a patient in good health, this difference generally has no consequence.

The piezoelectric device represents an investment, and its use requires training and regular practice. In Switzerland, ultrasonic rhinoplasty is therefore mainly found among surgeons who perform a large number of rhinoplasties, mostly in the major cities. Here is the situation, in the form of trends: always check with the practitioner whether they use the technique and to what extent.

Zurich

This is the city with the largest number of practitioners using ultrasonic instruments for rhinoplasty, often combined with preservation techniques. Patients from Winterthur, Zug, Schaffhausen, Baden and northern Schwyz can reach it in less than an hour.

Geneva and Lausanne

The two cities of the Lake Geneva region have several equipped practitioners. Patients from French-speaking Valais, Fribourg and Neuchâtel readily travel there for a rhinoplasty involving significant bone work.

Basel and Bern

There is real provision, in private practice and in hospitals. Basel attracts patients from Jura and the North-West, Bern those from the Mittelland, Solothurn and part of the Jura Arc.

Lucerne, St. Gallen and Lugano

A few practitioners there use the technique. For a wider choice, patients from Central and Eastern Switzerland also consult in Zurich, and those from Ticino in Lugano or north of the Alps.

Other regions

In medium-sized towns and cantons without a major centre, the technique is less often available. A photo-based pre-assessment lets you find out whether it would benefit your nose before you travel.

How to check that a practitioner really uses ultrasonic instruments

• Ask which steps they perform ultrasonically: only the osteotomies, or also lowering and sculpting the hump?
• Ask how long they have been using the device, and for what proportion of their rhinoplasties.
• Ask whether they work through the open or closed approach when using ultrasonic instruments.
• Check that the technique appears on the quote, with what it implies in terms of duration and cost.

The "availability" column describes a trend linked to the density of provision, not a list of practices. "Rare locally" means that patients generally turn to a neighbouring major centre for this technique.

For 52 Swiss cities, this table shows the centre where people generally consult for ultrasonic rhinoplasty, the indicative travel time by public transport, the likelihood of finding the technique there and the usual price difference compared with Geneva. As equipped practitioners are concentrated in the major cities, the recommended centre is not always the nearest: a resident of Chur or Frauenfeld will often turn to Zurich.

Using ultrasonic instruments generally adds an extra cost compared with a comparable conventional rhinoplasty, linked to the depreciation of the device, the inserts and a slightly longer operating time. The table below positions the options, taking as a base of 100 a full primary rhinoplasty performed with conventional instruments.

Details by city and the quote breakdown are on our page on ultrasonic rhinoplasty prices in Switzerland. When correction of the septum is covered by insurance, the use of ultrasonic instruments for the cosmetic part remains at the patient's expense.

The piezoelectric effect was discovered at the end of the nineteenth century by the Curie brothers: certain crystals produce an electrical voltage when compressed and, conversely, deform when a current is applied to them. For a long time, this property was used mainly in industry, sonar and watchmaking.

In medicine, ultrasound was first used for dental scaling. In the late 1990s and early 2000s, maxillofacial and dental surgeons developed devices capable of cutting bone precisely, notably for bone grafts before dental implant placement and for sinus surgery. They found that these instruments remarkably spared the sinus membrane and the nerves.

The idea of applying this technology to the nose took hold in the 2010s, driven by a few surgeons who published their first series and trained their colleagues. Manufacturers developed inserts specifically designed for the nasal pyramid. Since then, the technique has spread gradually, particularly among surgeons who perform many rhinoplasties and among those who have adopted preservation approaches.

Frequency

The insert vibrates at a frequency in the ultrasonic range, beyond what the human ear can hear, generally around twenty-five to thirty-five thousand vibrations per second depending on the device. This frequency is chosen to be effective on bone.

Amplitude

The movement of the tip is tiny, of the order of a few tens of micrometres. It is this low amplitude, combined with the high frequency, that allows fine, controlled cutting.

Power

The surgeon adjusts the power according to the step: stronger for an osteotomy in thick bone, gentler for finishing. Modern devices automatically adapt the power to the resistance encountered.

The effect on tissues

A rigid tissue such as bone cannot follow the vibration: it fragments on contact with the insert. An elastic tissue, such as a blood vessel or mucous membrane, oscillates with the insert and is not cut as long as contact remains light and brief.

Heat and irrigation

Any vibration generates heat through friction. Continuous irrigation keeps the bone temperature at a safe level, which protects the bone cells and promotes good consolidation.

Ultrasonic instruments produce slight heat on contact with the bone, due to the vibration of the tip. To avoid any heating of neighbouring tissues, the surgeon continuously irrigates the area with cold saline, which cools the instrument and removes bone dust. They work in small touches, without prolonged pressure in the same place.

This cooling is part of the rules for using these devices and partly explains why the procedure sometimes takes a little longer than with conventional instruments. Properly managed, it protects the mucous membrane, the small blood vessels and the skin covering the bridge of the nose.

Osteotomies are the cuts in the bone that allow the bony pyramid of the nose to be narrowed, straightened or closed. Understanding the different types helps you see what ultrasonic instruments bring.

Lateral osteotomy

This is the cut that separates the nasal bones from the cheek, along the base of the pyramid. It allows the walls to be brought together to narrow the nose or close the roof after a hump reduction. Depending on the line, it is described as low or high, with different effects on width and contour.

Medial osteotomy

It separates the nasal bones from the septum, near the midline. It makes it easier to move the walls, particularly when they are thick or a deviated nose needs to be recentred.

Transverse osteotomy

It connects the two previous cuts at the top, near the root, to fully mobilise a bone fragment.

With conventional instruments

These cuts are made with an osteotome struck with a mallet, from inside the nose or through tiny skin incisions. The surgeon follows the line by touch; the fracture can sometimes extend beyond the planned path.

With ultrasonic instruments

The ultrasonic saw cuts the bone under direct vision, along exactly the desired line, without uncontrolled fracture. The surgeon can also make partial cuts, which make the bone more flexible without separating it completely, to shape a contour.

The nasal hump generally combines a bony part, at the top, and a cartilaginous part, lower down. Its correction can follow several approaches.

Conventional resection

The surgeon removes the hump in one piece, bone and cartilage. The bridge is then left open, like a roof without a ridge, and it has to be closed with lateral osteotomies. This is the historical method, effective but it changes the structure of the bridge.

Lowering with a rasp

The surgeon lowers the bony part with small passes of a rasp, manual or ultrasonic. With ultrasonic instruments, they can sculpt the edges and surface to obtain a smooth line, without splintering.

Preservation

The bridge is kept intact and lowered as a block, after removal of a strip of bone and septum underneath. The bony part of the hump can be refined ultrasonically for a harmonious transition.

The choice

It depends on the size and shape of the hump, the width of the nose, the quality of the bones and the surgeon's experience. A moderate, regular hump lends itself well to lowering or preservation; an irregular or very large hump sometimes requires a conventional approach.

These fictitious profiles illustrate in which cases ultrasonic instruments were proposed, and in which they were not.

Nadia, 27, Geneva: a bony hump and thin skin

Nadia had a high, mainly bony hump on very thin skin. The surgeon proposed an open-approach rhinoplasty with ultrasonic lowering and sculpting, explaining that on her skin the slightest irregularity would show. She had little bruising, but a slightly swollen bridge for a few weeks.

Lukas, 34, Zurich: a nose deviated after a match

Lukas had deviated nasal bones after a blow during an ice hockey match and a deviated septum. The surgeon used ultrasonic instruments for the osteotomies and recentring of the bones, and corrected the septum conventionally. A coverage request was sent to his insurer for the functional part.

Émilie, 22, Lausanne: only the tip

Émilie wanted to refine her tip, as she was happy with her bridge. The surgeon explained that ultrasonic instruments would add nothing, since no bone work was planned, and proposed a conventional, less costly tip rhinoplasty.

Daniel, 48, Basel: a revision

Daniel had bony irregularities after an old rhinoplasty. The surgeon used finishing inserts to smooth the bridge, and ear cartilage grafts for the tip.

Aylin, 30, Bern: a wide root

Aylin found her nose wide between the eyes. Ultrasonic osteotomies allowed the root to be narrowed precisely. Her thick skin nevertheless hid some of the refinement achieved, as the surgeon had predicted.

Paolo, 41, Lugano: preservation and ultrasonic instruments

Paolo had a regular hump on a straight nose. The surgeon proposed a preservation rhinoplasty, with ultrasonic cuts at the base of the pyramid, which kept the natural line of his bridge.

Practitioners' websites often quote impressive figures on reduced bruising or swelling. To make sense of them, it helps to know how these studies are designed and what they actually measure.

What is measured

Most studies assess bruising and swelling around the eyes during the first few days, using visual scales scored by observers, sometimes from photos. Some measure the smoothness of the bony contours, pain, operating time or patient satisfaction. Few studies objectively assess the long-term aesthetic result.

The comparison

The most convincing studies compare rhinoplasties with and without ultrasonic instruments in similar patients, ideally randomly and with assessors who do not know which technique was used. Many studies are simpler: series of patients from a single surgeon, with no comparison group.

Enthusiasm bias

The first authors of a technique are often its most convinced advocates. Their results, obtained with great experience, are not always reproduced elsewhere to the same extent.

What can reasonably be concluded

The data point towards reduced bruising and periorbital swelling during the first week, and greater precision of bone cuts. They do not demonstrate clear superiority of the final aesthetic result or an overall reduction in touch-ups. The extra cost and slightly longer operating time need to be weighed up.

How to discuss it with the surgeon

Ask what ultrasonic instruments change in their own practice, what data they rely on and what they observe in their patients. A nuanced answer that acknowledges the technique's limitations is a good sign.

The thickness of the skin of the nose strongly influences the value of ultrasonic instruments. The surgeon assesses this from the consultation onwards, by gently pinching the skin of the bridge and tip.

On thin skin

The skin closely follows the skeleton of the nose. The slightest bony step, splinter or small asymmetry of the walls can become visible, sometimes months after the procedure, once the swelling disappears. The fine sculpting and smooth finishing made possible by ultrasonic instruments are then a real asset.

On medium skin

The benefit is real but less visible. The precision of the osteotomies remains valuable for symmetry and narrowing of the root.

On thick skin

The skin hides bony detail. The result depends mainly on the structure of the tip and the management of swelling, which can last more than a year. Ultrasonic instruments remain useful for significant bone work, but precision does not always translate into a visible gain.

The compromise

In patients with thin skin, the surgeon can also place a very thin layer of camouflage tissue on the bridge to smooth the result, in addition to bone sculpting.

Preservation rhinoplasty has seen a strong revival of interest since the late 2010s. Its principle is to keep the original bridge of the nose, with its line and cartilage covering, rather than removing and then rebuilding it. To lower this bridge, the surgeon frees the bony pyramid from its attachments and removes a strip of the underlying bone or septum.

These cuts must be precise, as they determine the height and stability of the new bridge. Ultrasonic inserts allow the osteotomies at the base of the pyramid and the cuts in the bony septum to be made very evenly. Many surgeons who practise preservation therefore use ultrasonic instruments.

This combination does not suit every nose. It is particularly suitable for regular humps on a straight bridge, with a correctly positioned tip. Very deviated noses, very irregular humps or revisions often require a conventional structural approach. The surgeon will explain why they are or are not proposing this approach.

After a first rhinoplasty, some patients are left with bony irregularities: a small residual hump, a palpable bony edge, asymmetrical walls or a root that has remained wide. In these situations, finishing inserts allow the bone to be smoothed and reshaped precisely, without repeating extensive fractures.

A revision nevertheless remains a complex procedure, whose difficulty lies mainly in the cartilage and scar tissue. Ultrasonic instruments only solve part of the problem. The surgeon often has to rebuild the tip or the middle third with cartilage grafts, taken from the ear or rib when the septum has already been used. Waiting at least a year after the first procedure remains the rule.

The device

A piezoelectric generator suitable for surgery represents a significant investment for a practice or clinic, which is recouped through procedures.

The inserts

Inserts wear out and must be replaced or sterilised according to strict protocols. Some are single-use.

Time

Wider exposure of the bone and gradual sculpting often lengthen the procedure, which increases theatre and anaesthesia costs.

Training

The surgeon has invested in specific training and a learning curve.

What does not change

Fees for work on the septum, tip and grafts remain comparable to those for a conventional rhinoplasty.

Geneva

Several Geneva practitioners use piezosurgery for the nose, often as part of open-approach rhinoplasties. For a bony hump on thin skin, it is an easily accessible option for Geneva residents.

Vaud

Lausanne has several equipped practitioners. Patients from the Riviera, northern Vaud and La Côte can reach them in less than an hour.

Neuchâtel

The technique is less widespread locally; many Neuchâtel residents turn to Lausanne or Bern when they want it.

Jura

Basel is the most accessible centre for Jura residents who want ultrasonic rhinoplasty.

Fribourg

Lausanne and Bern, half an hour away, offer a choice of equipped practitioners; patients often choose according to language.

Valais

French-speaking Valais residents consult in Lausanne or Geneva, Upper Valais residents in Bern.

Bern

Bern has equipped practitioners in private practice; complex functional cases can be referred to the university ENT department.

Zurich

Zurich is the city where the technique is most widespread, often combined with preservation rhinoplasty.

Lucerne

A few Lucerne practitioners use ultrasonic instruments; Zurich, an hour away, widens the choice.

Uri

Uri residents consult in Lucerne or Zurich.

Schwyz

The north of the canton naturally looks to Zurich, the south to Lucerne.

Obwalden

Lucerne is the usual centre, about twenty minutes away.

Nidwalden

Lucerne, a quarter of an hour away, then Zurich for a wider choice.

Glarus

Zurich, about an hour away, offers the widest choice.

Zug

Zurich, twenty-five minutes away, is the reference centre for this technique.

Solothurn

From Olten, Zurich, Basel and Bern can be reached in less than forty minutes.

Basel-Stadt

Basel has several practitioners who use ultrasonic instruments.

Basel-Landschaft

Patients consult in Basel, close by.

Schaffhausen

Zurich, forty minutes away, is the usual centre.

Appenzell Ausserrhoden

St. Gallen first, Zurich to widen the choice.

Appenzell Innerrhoden

St. Gallen, then Zurich.

St. Gallen

A few St. Gallen practitioners use the technique; Zurich is an hour away.

Graubünden

Most Graubünden patients looking for the technique consult in Zurich.

Aargau

Zurich, twenty minutes from Baden, is the reference centre; the west of the canton can also look to Basel.

Thurgau

Zurich, less than an hour away, or St. Gallen for the east of the canton.

Ticino

A few Lugano practitioners use it; some patients consult north of the Alps.

• What is the bony share of my hump or width, and therefore the real value of ultrasonic instruments for me?
• For which specific steps will you use the device?
• Will you operate through the open or closed approach, and why?
• How long have you been using ultrasonic instruments, and for what proportion of your rhinoplasties?
• How do you plan to treat my tip and my breathing?
• What swelling should I expect on the bridge of my nose, given the undermining?
• What does the extra cost of the technique represent in your quote?
• Can you show me results at one year in patients with a comparable nose?

A surgeon who answers precisely, without presenting the technique as a miracle solution, gives you a good indication of their mastery.

Rhinoplasty changes the face permanently. It is legitimate to consult two surgeons, especially if their proposals regarding technique, ultrasonic instruments or combined procedures differ. Bring your photos and questions, and compare the clarity of the explanations, the analysis of your face and the results shown at one year. Choosing a surgeon experienced in rhinoplasty matters more than the tool used.

Eight weeks before

Stop smoking and nicotine: the skin of the nose will be undermined more than in conventional rhinoplasty, and its blood supply matters. If you have allergies, have your rhinitis treated.

Four weeks before

Carry out the pre-operative check-up. If a functional part is planned, check your insurer's reply. Organise two weeks of recovery and a solution for your glasses.

Two weeks before

On medical advice, suspend products that encourage bleeding. Prepare saline solution, cold compresses, a humidifier and pillows.

The day before

Wash your hair, remove make-up and nose piercings, and follow the fasting instructions.

Day 1

Nose blocked by the splint and swelling, breathing through the mouth, slight pressure on the face. The eyes are often only slightly marked.

Days 2 and 3

Facial swelling reaches its peak. Bruising, when it appears, often remains discreet under the eyes. Gentle saline rinses according to the instructions.

Days 4 and 5

You feel better. Any bruises are already turning yellow. Short walks are possible.

Days 6 and 7

Splint removal: the bridge looks thick, sometimes more than expected, because of the undermining. It will refine over the following weeks.

Saline rinses, prescribed by the surgeon, help remove crusts and dried blood from inside the nose and improve breathing during healing. They are done gently, without strong pressure, several times a day for two to three weeks. Do not blow your nose hard or put anything into the nostrils; simply wipe the entrance of the nose with a gauze pad.

Ice hockey, football and combat sports

Contact sports players, who are often affected by bony deviations, should allow about three months before returning to competition. Ultrasonic precision does not shorten this period.

The ski season

Ski goggles rest on the bony part of the nose, precisely the part worked on with ultrasonic instruments. Wait for consolidation, generally two to three months.

Pollen

Schedule the procedure outside your allergy season to avoid sneezing and congestion during healing.

Working from home

With bruising that is often discreet, many patients return to work remotely from the second week.

Train or car journeys are possible from the first few days, avoiding carrying heavy luggage. For long trips, it is better to wait until the first check-up and splint removal. Stays at altitude or in intense sun require careful protection of the nose, and activities with a risk of impact should be avoided for several weeks.

Take your rinsing products and prescription with you.

Whether the bones are cut with a chisel or ultrasonically, they must then knit together in their new position. Understanding this process explains why some precautions last several weeks, even when the face already looks normal.

The first few days

A small clot forms between the bone fragments, then cells move in to prepare the repair. The bones are then mobile, held by the splint and the surrounding tissues. An impact or pressure could displace them.

The following two to six weeks

A repair tissue, at first soft and then increasingly mineralised, connects the fragments. Strength increases gradually, but remains lower than that of normal bone. That is why glasses must not press on the bridge of the nose during this period.

The following months

The bone remodels and regains its usual strength. At around two to three months, consolidation is sufficient to resume sports involving goggles or a risk of impact.

The role of ultrasonic instruments

Clean cuts without splintering, and a temperature controlled by irrigation, provide good conditions for consolidation. They do not, however, shorten the biological timescales, which are the same for everyone.

The nasal bones regain enough strength for daily life within a few weeks, but complete consolidation takes about three months. Sports in which facial impacts are frequent, such as football, ice hockey, martial arts or handball, generally have to wait this long, and facial protection is advisable on returning. A violent blow to the nose during recovery requires prompt medical attention, even without significant pain.

"It is rhinoplasty without surgery"

It is a full surgical rhinoplasty, under general anaesthesia, with incisions and undermining. Only the instrument used for the bone changes.

"Ultrasonic instruments also sculpt the tip"

Ultrasonic instruments do not cut cartilage effectively. The tip is always worked on conventionally.

"There is no bruising"

Bruising is often less marked, but it can occur, depending on the patient and the extent of the osteotomies.

"The result is necessarily better"

Studies do not show systematic superiority of the final result. The result depends mainly on the surgeon and the surgical plan.

"You recover in a few days"

You often look presentable sooner, but bone consolidation and reduction of tip swelling follow the usual timescales.

"Every nose benefits"

A rhinoplasty limited to the tip or cartilage gains no benefit.

"A surgeon without ultrasonic instruments is out of date"

Many excellent surgeons obtain remarkable results with conventional instruments.

A patient sometimes consults two practitioners: one proposes ultrasonic rhinoplasty, the other a conventional rhinoplasty. How should you choose?

Compare the diagnoses

Do the two practitioners read your nose in the same way: bony and cartilaginous share of the hump, width, tip, breathing? If one has noticed a problem the other has overlooked, that is an important factor.

Compare the plans

What do they propose for the tip, septum and nasal valve? These steps, identical in both techniques, determine a large part of the result.

Compare experience

How many rhinoplasties does each perform per year? A very experienced surgeon using conventional instruments may give a better result than a less experienced surgeon using ultrasonic instruments, and vice versa.

Compare simulations and results

Look at results at one year for noses comparable to yours.

Compare the rapport

Trust and clear explanations also matter a great deal for a procedure whose result emerges over a year.

In short, the technique is a secondary criterion. If both practitioners inspire the same confidence and propose equivalent plans, the value of ultrasonic instruments will depend mainly on the extent of the bone work and the thickness of your skin.

• A wide, round or drooping tip, which depends on the alar cartilages.
• Wide or asymmetrical nostrils, which call for alar base reduction.
• A deviation of the cartilaginous septum, corrected conventionally.
• A narrow nasal valve, which requires supporting grafts.
• A low bridge, which requires augmentation with grafts.
• The quality and thickness of the skin of the nose.
• How long the tip stays swollen.

For these aspects, see our general page on rhinoplasty and our page on septoplasty.

An ultrasonic rhinoplasty involves the same team as a conventional rhinoplasty: surgeon, anaesthetist and theatre nurses. The device adds a few elements to the organisation. The generator is set up near the operating field, with its foot pedal and irrigation system. The inserts are prepared in the planned sequence. Suction continuously collects the irrigation fluid and debris. The surgeon adjusts the power for each step and regularly checks the symmetry of the cuts. After the procedure, the inserts are cleaned and sterilised, or discarded if they are single-use. This organisation explains part of the extra time and cost of the technique.

An ultrasonic rhinoplasty involves a whole team: the anaesthetist, who ensures sleep and stable blood pressure, which limits bleeding; the scrub nurse, who prepares and maintains the inserts; and the circulating nurse, who manages irrigation and suction. The coordination of this team contributes to the precision of the procedure and to safety. After the operation, the recovery room team monitors breathing, pain and bleeding before the patient returns to their room or goes home.

Ultrasonic devices and their inserts are medical devices that require rigorous maintenance: sterilisation after each use, checking insert wear and regular servicing of the generator. A worn insert cuts less well and lengthens the procedure. Reputable facilities keep a record of these checks. At the consultation, you can ask whether the facility has its own device and how long the team has been using it.

These trends vary greatly from one patient to another. They show that the difference mainly concerns the first week or two.

Ultrasonic instruments are much quieter than the mallet and chisels used in conventional techniques, but the patient is asleep during the procedure anyway. What matters to them is how they feel on waking: many patients operated on with ultrasonic instruments describe less feeling of impact in the head and a less swollen face, although these differences vary greatly from person to person and with the extent of the bone work.

Do not expect a recovery without swelling or bruising: the skin has been undermined and the cartilage worked on, and these after-effects remain. The advantage of ultrasonic instruments lies mainly in reduced trauma to the tissues around the bone.

Men make up a large share of the patients for whom ultrasonic instruments are useful, as their requests often concern noses deviated after an injury or pronounced bony humps. Their bones are sometimes thicker, and an old fracture may have healed irregularly. Controlled cutting then makes it easier to reposition the fragments and correct irregularities. The aim remains a straight, strong bridge without a dip. For contact sports players, the same return timescales apply, and facial protection can be discussed.

With age, the nasal bones become thinner and more fragile. With an osteotome, they may fracture less predictably. The gradual cutting of ultrasonic instruments then offers better control. In older patients, rhinoplasty often aims to support a drooping tip and reopen the nasal valve, cartilage work that ultrasonic instruments do not affect; bone work, when needed, does however benefit from this precision.

Choosing the practitioner for the device

The surgeon's experience in rhinoplasty counts for far more than the instrument they use.

Paying unnecessary extra costs

If your rhinoplasty involves no bone work, ultrasonic instruments add nothing.

Thinking you have healed faster

Less bruising does not mean the bones have consolidated sooner: respect the timescales for glasses, sport and ski goggles.

Worrying about a swollen bridge

Wider undermining can thicken the bridge for a few weeks. This is expected.

Judging too soon

The result is judged at one year, as for any rhinoplasty.

Using ultrasonic instruments does not change the coverage rules. If your rhinoplasty includes a functional part, such as correcting a deviated septum that impairs breathing, this part can be the subject of a prior cost approval request to your insurer, with a medical report. If accepted, it is covered under the usual rules. The cosmetic part, including the extra cost of using ultrasonic instruments to sculpt the bridge, remains at your expense. If the deformity results from an accident, accident insurance may be involved. Always ask for a written answer before the procedure, and a quote that clearly separates the two parts.

To find out whether ultrasonic instruments would be useful for your nose, the surgeon needs to assess the bony share of the hump and width. A few well-taken photos often allow an initial assessment.

• A strict profile on each side, to see the height and shape of the hump.
• A front view, to judge the width of the root and any deviation.
• Two three-quarter views, which reveal irregularities of the bridge.
• A view from below, for the tip and nostrils.

Say whether you can feel a hard, immobile hump at the top of your nose, whether you have had a blow, and whether you breathe badly on one side.

Palpating the bridge

They feel the bridge of the nose to find where the hard bony part ends and the softer cartilaginous part begins. This boundary indicates how much of the work can be done ultrasonically.

Width of the root

From the front, they compare the width of the root of the nose with the distance between the eyes and look for any asymmetry of the bony walls.

History of injury

An old fracture, sometimes forgotten, may have left thickened or misaligned bones, a good indication for precise cutting.

Skin thickness

By pinching the skin of the bridge and tip, they assess whether bony detail will be visible after the procedure.

Breathing

They examine the inside of the nose to assess the septum, turbinates and valve, and check that bony narrowing will not impede airflow.

It is often hard to find the words to describe the nose you want. Rather than bringing photos of celebrities, it is useful to describe what bothers you about your own nose: a hump, a drooping tip, a nose too wide from the front, a deviation. The surgeon can then explain what is achievable with your skin, bones and face, and show you a simulation. This honest discussion reduces the risk of a gap between expectations and result.

Narrowing the bony part of the nose brings its walls closer together. If this narrowing is too great or poorly placed, it can reduce the space under the middle third, at the junction with the nasal valve, and impair breathing. The surgeon takes this into account when choosing the osteotomy line and the extent of narrowing.

The precision of ultrasonic instruments allows the exact level of the cut to be chosen and the movement of the walls to be controlled. But preserving breathing also depends on supporting the middle third, for example with grafts placed along the septum when the valve is weak. This is an example of the complementarity between ultrasonic bone work and conventional cartilage work.

Ultrasonic instruments improve the precision of bone work, but they do not on their own treat the causes of nasal obstruction: deviated septum, enlarged turbinates, narrow nasal valve. These problems call for specific steps, carried out during the same procedure if necessary. An examination of nasal breathing before the operation is therefore essential. See our page on septoplasty.

Before

You arrive having fasted, accompanied, without make-up or piercings. The surgeon reviews the plan and simulation with you, and the anaesthetist checks your file.

During

You are asleep throughout the procedure. You hear neither the device nor the irrigation. The procedure often takes a little longer than a conventional rhinoplasty.

On waking

The nose is blocked by the splints and the throat a little dry. The eyelids are often only slightly swollen, which pleasantly surprises many patients.

Discharge

Depending on the facility and the duration, you go home the same evening or the next day, with your instructions and the date for splint removal.

On waking, the splint is in place on the nose, sometimes with small internal splints. You breathe through your mouth, which dries the throat: drinking regularly and humidifying the room help. Cold on the cheeks and eyelids, through a compress, limits swelling, which peaks around the second day. Pain is generally moderate.

Sleep with your head raised, do not blow your nose, sneeze with your mouth open and avoid exertion. A little bleeding is normal; heavy bleeding or a high fever require you to contact the team.

Applying cold to the cheeks and eyelids, never directly on the splint or the nose, reduces swelling and bruising during the first two or three days. Use cold compresses or gel packs wrapped in a cloth, in sessions of about fifteen minutes. After the third day, cold brings less benefit; keeping the head raised and gentle walking take over.

Once the splint has been removed, make-up can be used to hide residual bruising, avoiding rubbing the nose. A peach or yellow concealer neutralises purplish or greenish marks. Remove make-up by gently dabbing. Exfoliating products, masks and facial care devices have to wait a few weeks, and the skin of the nose must be protected from the sun.

Working from home is often possible from the end of the first week, once the splint has been removed, provided you keep your head fairly upright and take breaks. Returning to the office depends mainly on appearance: many patients prefer to wait until the bruising has gone, ten to fifteen days. Physical jobs, or those that expose you to dust or impacts, require two to three weeks, sometimes more. The sick note does not state the nature of the procedure.

The root of the nose, between the eyes, is an area where the bone is thicker and where the transition to the forehead must remain smooth. Clumsy narrowing can create a visible step, asymmetry or a pinched look. It is also an area where a conventional fracture can extend beyond the planned path. Ultrasonic cutting, performed under direct vision, allows the narrowing to be judged precisely and the transition to be smoothed. In patients who seek advice for a nose that is "wide between the eyes", this is often where the technique shows its value most clearly.

Piezosurgery is part of a wider movement of technologies serving precision. Standardised photography and digital simulation allow better planning of the result and better dialogue with the patient. Three-dimensional imaging helps some surgeons analyse the volumes of the nose and face. Endoscopy of the inside of the nose refines the functional diagnosis. These tools improve planning and communication, but none replaces the surgeon's eye and experience. Rhinoplasty remains a craft, in which every nose is unique.

An ultrasonic rhinoplasty takes place in a clinic or facility with an operating theatre equipped with the piezoelectric generator, a recovery room and, if necessary, the possibility of an overnight stay. Some surgeons own their device and bring it to the facilities where they operate; others use the clinic's equipment. Ask where the procedure will take place, whether a night is planned and how any complications would be managed. Facility and equipment costs must appear on the quote.

Identify the bony share

A hard hump at the top of the nose, a wide root, deviated bones: these are the situations in which ultrasonic instruments are useful.

Get a first opinion

A pre-assessment based on photos indicates whether the technique is relevant for you.

Consult a practitioner who uses it regularly

Ask them about the steps performed ultrasonically and about their experience.

Compare like for like

If you also consult a practitioner who does not use ultrasonic instruments, compare the diagnoses and plans, not just the instruments.

Organise your recovery

Allow two weeks, a solution for your glasses and a break from sports involving goggles or contact.

The versatility of the technique depends on the variety of inserts, the interchangeable tips that the surgeon attaches to the handpiece.

Rasps

They have a rough surface, of varying fineness. The coarsest quickly lower a thick bony hump; the finest smooth the surface and remove small irregularities. The surgeon moves from one to the other as the sculpting progresses.

Saws

Thin and sharp, they perform osteotomies along a precise line. Their reduced thickness limits the amount of bone removed during the cut.

Shaping tips

Rounded or ball-shaped, they allow a contour to be refined, an area to be slightly hollowed or a transition to be softened, for example between the root and the forehead.

Protected inserts

Some inserts have a smooth, inactive side that protects the soft tissues on the side opposite the cut.

Maintenance

Inserts wear with use. Replacing them regularly ensures effective and safe cutting.

Thick bones

In some people, often men, the nasal bones are thick and resistant. With an osteotome, they may fracture irregularly; ultrasonic cutting, which is more gradual, offers better control.

Thin bones

In others, particularly with age, the bones are thin and fragile. Cutting without percussion limits the risk of splintering and fragmentation.

Old fractures

After a poorly healed fracture, the bones may show thickening, steps or misalignment. Fine sculpting and precise cuts make realignment and smoothing easier.

Asymmetries

When the two bony walls do not have the same thickness or inclination, the surgeon can treat each side differently, with suitable cuts and shaping.

Ultrasonic rhinoplasty can be combined with other facial procedures, just like a conventional rhinoplasty.

• A genioplasty, to balance the profile, as part of a rhinoplasty and genioplasty.
• Buccal fat removal, to slim the cheeks, as part of a rhinoplasty and buccal fat removal.
• Double chin treatment, as part of a profileplasty.
• A septoplasty, to correct breathing at the same time.

The combination lengthens the procedure, which is already a little longer with ultrasonic instruments. The surgeon assesses whether it remains reasonable for your health.

After an ultrasonic rhinoplasty, the bridge of the nose generally becomes defined within two to three months, once the swelling linked to undermining has resolved. The smoothness obtained by sculpting then becomes visible, particularly in profile and at three-quarters. The root, if it has been narrowed, refines at the same time. The tip, worked on conventionally, continues to change for twelve to eighteen months. The one-year review, with photos taken under the same conditions as before the procedure, allows the whole result to be judged objectively.

The nose changes a great deal during the first year: at first swollen and slightly upturned, it gradually refines, starting with the bridge and then the tip. Taking front, profile and three-quarter photos at regular intervals, in the same light, allows you to follow this change without relying on your impression in the mirror, which is often misleading. These photos are also useful at check-ups, particularly remote ones, to discuss a detail with the surgeon.

Noses with a low bridge, a wide root and thick skin, common in some ethnic backgrounds, often need augmenting or supporting rather than reducing. In these situations, most of the work relies on cartilage grafts to raise the bridge and project the tip. Ultrasonic instruments can nevertheless be useful to narrow a wide root precisely. Our page on ethnic rhinoplasty details these approaches.

Your family doctor can prescribe the pre-operative check-up, review your treatments and follow the first few days close to home. If you suffer from chronic rhinitis, sinusitis or a breathing problem, an ENT specialist in your region can complete the assessment before the procedure and monitor your breathing afterwards. Give these practitioners a copy of the operative report, which specifies the steps performed ultrasonically.

Piezoelectric effect. The property of certain materials to deform under the effect of an electric current.

Generator. The device that produces the alternating current converted into vibrations.

Insert. The interchangeable tip of the handpiece: rasp, saw or shaping tip.

Irrigation. Continuous spraying of sterile fluid to cool the bone.

Osteotomy. Controlled cutting of the nasal bone.

Osteotome. A chisel struck with a mallet, the conventional instrument for osteotomies.

Periosteum. The thin membrane covering the bone, lifted to expose the bony pyramid.

Piezo rhinoplasty. Another name for ultrasonic rhinoplasty.

Bony pyramid. The upper part of the nose, formed by the nasal bones.

Rasp. An insert or instrument that lowers and smooths bone by friction.

Rhinosculpture. Gradual shaping of bone in small touches.

Selectivity. The instrument's ability to cut bone while sparing soft tissues.

To give you a concrete idea, here is the fictitious but realistic account of the first three weeks of a 29-year-old patient who had a bony hump corrected by ultrasonic rhinoplasty.

Day 1

"Woke up with a blocked nose and a dry throat. I was expecting very swollen eyes: they barely are. Night spent sitting up on three pillows."

Day 3

"My face is a little puffy, with a slight yellow shadow under my left eye. I do the saline rinses three times a day. Breathing through my mouth is still the most unpleasant part."

Day 7

"Splint removed. My nose looks wide and thick along the bridge, which worries me, but the surgeon explains that it is swelling due to the undermining. The profile is already straight."

Day 10

"Back to working from home. Hardly any marks left under my eyes. I'm wearing my contact lenses instead of my glasses."

Day 14

"Back at the office. Nobody notices anything in particular, apart from a colleague who thinks I look rested. My nose is still a little stiff to the touch."

Day 21

"The bridge is clearly slimmer in the evening, less so in the morning. I'm sticking to the ban on contact sports and glasses on my nose."

Every patient progresses differently; this diary illustrates a favourable, typical recovery, not a guarantee.

A surgeon who wants to incorporate ultrasonic instruments into their rhinoplasty practice generally attends specific courses, often organised at congresses or as hands-on training on anatomical specimens. There they learn how to set up the device, choose the inserts, manage irrigation, expose the bony pyramid and perform the cuts used in preservation. Mastery then comes with practice: the first procedures take longer, and precision improves with each case. That is why it is useful to ask how long the surgeon has been using the technique and how often.

The bridge of the nose

Persistent swelling of the bridge is expected for a few weeks. A hard lump that appears or grows, however, must be reported to the surgeon.

The root

Tenderness between the eyes is common at first. Increasing pain or redness requires medical attention.

The skin

The skin of the bridge, which has been undermined more widely, should keep a normal colour. An area that turns pale, becomes very red or darkens must be shown to the surgeon without delay.

Breathing

It improves gradually after the splints are removed. A painful blockage on one side may suggest a septal haematoma.

The eyes

A drop in vision, which is extremely rare, requires immediate medical attention.

• Explicit mention of the use of ultrasonic instruments and the steps concerned.
• The approach, open or closed.
• Separation between the functional and cosmetic parts.
• Any cartilage grafts and their origin.
• The surgeon's and anaesthetist's fees.
• Facility, equipment and insert costs.
• The splint, check-ups and care included.
• VAT and touch-up conditions.

Two quotes are only comparable if they cover the same steps. An ultrasonic rhinoplasty quote that does not specify what will be done ultrasonically does not tell you what you are paying for. Details by city are on our page on ultrasonic rhinoplasty prices in Switzerland.

Many candidates for ultrasonic rhinoplasty are between twenty and thirty-five. For them, organisation matters as much as technique. University holidays or a break between jobs are good times. With bruising that is often discreet, a return to studies or work is frequently possible after ten to fourteen days. Important exams, job interviews or business trips should be avoided in the first two weeks. For university athletes, contact sports have to wait about three months. Finally, it is worth planning the budget: the extra cost of ultrasonic instruments is only justified if the bony part of the work is significant.

A deviated nose is almost never crooked in just one place. The surgeon analyses the deviation level by level, which determines how much of the work is done ultrasonically.

The bony pyramid

The nasal bones may be tilted to one side, with one wall more vertical than the other. Ultrasonic osteotomies allow them to be freed and recentred precisely.

The middle third

The upper lateral cartilages often follow the deviation of the septum. They are straightened with sutures and grafts, conventionally.

The septum

A deviated septum pulls the nose to one side. Correcting it is essential for the nose to stay straight.

The tip

The tip may be off-centre because of asymmetry of the alar cartilages or of the front of the septum.

The result

A nose that has been very deviated for a long time may retain a slight tendency to deviate, due to the memory of the cartilage or asymmetry of the face. The aim is a clear improvement, not always perfect straightness.

Many faces have slight asymmetry: one half wider, one cheekbone higher, a chin slightly off-centre. A perfectly straight nose on an asymmetrical face may then look deviated. The surgeon analyses the whole face before planning to straighten the nose, and explains what can be achieved. Ultrasonic instruments help perform precise, asymmetrical osteotomies to correct a deviated nose, but they do not correct the asymmetry of the face itself.

From the front, a harmonious nose has two slightly curved lines of light running from the head of the eyebrows down to the tip. These lines depend on the shape of the bony pyramid and the middle third. A hump, excessive width or asymmetry of the walls distorts them: they spread apart, break or become irregular.

Ultrasonic sculpting allows these lines to be redrawn precisely, by narrowing the pyramid and smoothing the transitions. It is an objective often highlighted by surgeons who use the technique: a bridge with an even light reflection, without unexpected steps or shadows. This detail is particularly visible in front-on photos and in raking light.

As after any rhinoplasty, a small touch-up may be needed in some patients. Bone-related touch-ups, such as a small residual hump or a palpable edge, should be less frequent thanks to the precision of the bone work, although the data to prove this formally are lacking. Tip touch-ups, which depend on the cartilage and healing, are not affected. A touch-up is discussed at least a year after the procedure. It is often simpler than the initial procedure and can sometimes be performed under local anaesthesia. Ask about the touch-up conditions before the procedure.

A touch-up after rhinoplasty is generally only discussed after a year, sometimes longer for thick skin. Before then, residual swelling, especially at the tip, makes it impossible to judge the result precisely, and the scar tissue is still remodelling. Operating too early risks correcting a defect that would have disappeared on its own, or operating on tissues that are still inflamed.

During the year following the procedure, many questions may arise: swelling that seems asymmetrical, a small lump to the touch, temporary breathing difficulty. Do not hesitate to contact the practice. A photo taken in good conditions, from the front and in profile, often helps the surgeon answer quickly. Most of these concerns are related to the normal course of healing. For warning signs such as heavy bleeding, fever or reduced vision, however, seek medical attention without delay.

An ultrasonic rhinoplasty often takes a little longer than a conventional rhinoplasty. In a patient in good health, this difference is well tolerated. The anaesthetist keeps blood pressure rather low to limit bleeding, protects the airway and prevents nausea. If you have a particular medical history, such as sleep apnoea, heart disease or difficulties with a previous anaesthetic, mention it at the anaesthesia consultation. The longer duration may also point towards a night at the clinic rather than going home the same evening.

The first few days

You will breathe through your mouth and will need peace and quiet. Bruising may be discreet, but your nose will be blocked and swollen.

Splint removal

The nose will look thick at that point. Warn those close to you that the result should not be judged for several months.

Useful help

Someone to accompany you on the day of the procedure and for splint removal, easy meals, and a friendly reminder of the instructions: no hard nose-blowing, no glasses on the nose, no contact sports.

Young children who jump into your arms or accidentally headbutt you are a real risk for a freshly operated nose, especially in the first two weeks when the bones have not yet consolidated. Arrange help with childcare, explain to the children that they must avoid their parent's face for a while, and avoid carrying them. After splint removal, vigilance remains necessary for about six weeks.

Untreated allergic rhinitis prolongs nasal congestion during healing and increases the risk of bleeding when sneezing. Have it treated before the procedure and schedule the procedure outside your allergy season. During pregnancy, the nasal mucous membrane often swells under the effect of hormones; rhinoplasty, ultrasonic or not, is postponed until after pregnancy and, generally, after breastfeeding.

At one year, the bridge and root have reached their final shape, and the tip has largely refined. Comparative photos show the smoothness of the bone work. Most patients no longer need any particular follow-up. Protect your nose from sun and impacts, and seek advice if a breathing problem reappears years later. The bony result is permanent; the nose will simply continue to age with the rest of the face.

The bony pyramid, worked on with ultrasonic instruments, is precisely where the nose pads of glasses rest. During consolidation, generally four to six weeks, nothing must press on it. Contact lenses are the simplest solution; otherwise, glasses suspended from the forehead with gentle adhesive tape or a frame without nose pads allow you to wait. The surgeon will tell you the exact interval according to the steps performed.

After an ultrasonic rhinoplasty, the bridge of the nose may feel stiff and slightly thickened for a few weeks, due to the wider undermining and healing under the skin. You may also feel fine irregularities, which usually correspond to swelling or small areas of healing and fade over time. The skin of the bridge may be slightly numb at first. Avoid constantly touching your nose: it speeds nothing up and feeds anxiety. If a hard lump appears or grows noticeably, show it to the surgeon.

Even a surgeon who uses ultrasonic instruments extensively regularly returns to conventional instruments. Cartilage, which is soft, is better cut with a scalpel. Some very deep cuts or those in hard-to-reach areas are simpler with a fine manual instrument. For a small bony touch-up, a manual rasp may be enough without setting up the device. Finally, the exposure required for extensive use is not always desirable in a patient with fragile skin. A good surgeon chooses the most suitable tool for each step, rather than applying a single technique to everything.

Preservation rhinoplasty can be performed with conventional instruments or with ultrasonic instruments. The cuts at the base of the pyramid, which allow the bridge to be lowered in one block, require great precision: too little bone removed, and the bridge does not drop enough; too much, and it becomes unstable. Ultrasonic instruments make this fine-tuning easier, which explains their popularity among proponents of preservation. But experienced surgeons also perform excellent preservation rhinoplasties with fine saws and chisels. Here again, mastery counts for more than the tool.

The smoothness of a bony bridge is judged particularly well in raking light, when the light comes from the side or from above and reveals relief. It is also in these conditions that small irregularities, invisible in soft light, may appear. At the review, the surgeon takes photos under standardised conditions and may supplement them with views in more raking light. To judge your result yourself, favour natural light from the front and photos taken from a distance, rather than close-up selfies under ceiling lighting.

As for any rhinoplasty, digital simulation serves to agree on a direction: height of the bridge, width of the root, shape of the tip. For ultrasonic rhinoplasty, it also allows you to visualise the expected effect on the width of the bony pyramid and on the lines of the bridge seen from the front. It remains a two-dimensional image that takes account of neither skin thickness nor healing. Keep it as a reference for the agreed objective, and compare the result at one year.

If you live far from the practitioner, splint removal, around the seventh day, must take place at the practice. Later check-ups can often be supplemented by photos sent to the surgeon, taken from the front, in profile and at three-quarters in good conditions. Your family doctor or a nearby ENT specialist can monitor breathing and rinsing. The one-year review is ideally done at the practice, for standardised comparative photos.

To use the inserts while seeing the bone, the surgeon lifts not only the skin but also the periosteum, the thin membrane that covers the bone and contributes to its blood supply. This plane of undermining, directly in contact with the bone, has several advantages: it bleeds little, it protects the soft tissues that remain attached to the skin, and it gives a direct view of the bony pyramid. At the end of the procedure, the periosteum is put back in place over the sculpted bone, where it contributes to consolidation and smoothing of the contour. This undermining, more extensive than with conventional osteotomies, explains the sometimes longer-lasting swelling of the bridge, which resolves within a few weeks.

Although most extensive use is through the open approach, some surgeons use ultrasonic instruments through the closed approach, without an incision on the columella. They then introduce the inserts through the incisions inside the nostrils, with more limited undermining. This approach is mainly suitable for osteotomies and moderate lowering of the hump. It avoids the scar on the columella and may limit tip swelling, but it offers a less complete view of the bone. The choice depends on the nose and the surgeon's experience with each approach. Ask which one they are considering and why.

In patients with very thin skin, even a precisely sculpted bony bridge may reveal tiny reliefs once the swelling has gone. To avoid this, some surgeons place a thin layer of tissue on the bridge of the nose before closing: finely crushed cartilage, fascia taken from behind the ear or from the temporal region, or perichondrium. This cushion smooths the contour and protects against visible irregularities. It complements ultrasonic sculpting without replacing it. If your skin is thin, ask the surgeon whether they are considering this step.

Some patients are reassured by the idea of a modern, precise instrument, without mallet blows. Others are worried about a technology they do not know. In both cases, it helps to come back to the essentials: the device is a tool in the surgeon's hands. Its safety depends on the skill of the person using it, irrigation and correct settings. What should reassure you above all is an experienced surgeon who explains clearly what they will do, why, and what you can expect. Do not hesitate to ask them to show you the device and inserts if it helps.

• Does the facility have the device, or does the surgeon bring their own?
• Is the procedure planned as day surgery or with a night's stay?
• How are monitoring and the management of any complication organised?
• Which facility and equipment costs appear on the quote?

When ultrasonic instruments are used extensively, the open approach is common, with a small step-shaped or inverted-V incision on the columella. The stitches are removed around the seventh day, with the splint. The scar is pink for a few weeks, then fades. In most patients, it becomes almost invisible within a few months, provided it is protected from the sun and the recommended care is followed. On some skin types prone to pigmentation, it may remain slightly more visible; local treatment can then help.

When the procedure is performed through the closed approach, all the incisions are inside the nose and invisible. With the open approach, only a small scar crosses the columella, between the nostrils, and becomes very discreet within a few months. Inside, the mucous membrane heals in two to three weeks; crusts and a blocked feeling are normal during this period.

The high, pointed hump

Located near the root, often bony, it lends itself well to gradual lowering with an ultrasonic rasp, with particular attention to the transition with the forehead.

The long, rounded hump

It involves both the bony and cartilaginous parts. Ultrasonic instruments treat the upper part; the lower, cartilaginous part is lowered with a scalpel, then the whole is harmonised.

The asymmetrical hump

More marked on one side, often after an impact, it requires different sculpting of each wall, which the precision of the inserts makes easier.

The small isolated hump

It can sometimes be smoothed with a simple rasp, ultrasonic or manual, without osteotomy, through the closed approach.

A residual hump after rhinoplasty

Finishing inserts allow it to be revised precisely, without repeating a full procedure.

Ultrasonic instruments act on bone: they are used for the hump, the side walls and the root of the nose. The tip, by contrast, is made of soft cartilage and is shaped with other techniques: sutures, cartilage grafts, repositioning. A so-called ultrasonic rhinoplasty therefore always combines conventional techniques for the cartilaginous part of the nose. When the request mainly concerns the tip, the value of ultrasonic instruments is limited, and the surgeon should be chosen for their overall experience in rhinoplasty rather than for the instrument.

Beyond the price of the procedure, a few additional costs should be planned for: the initial consultation, often charged; the pre-operative check-up; saline solution and medication; a temporary vision solution if you wear glasses, such as contact lenses; journeys to the practice, particularly for splint removal if you live far away; and days off work. If a functional part is covered by your insurer, the deductible and co-payment apply according to your policy. These items remain modest, but they add up and are worth anticipating.

Patients who opt for ultrasonic rhinoplasty often give three reasons. The first is the prospect of less bruising, which makes a quick return to work or studies easier. The second is the search for a very smooth bridge, particularly among those with thin skin or a pronounced bony hump. The third is confidence in a surgeon who has incorporated this technique into a substantial rhinoplasty practice. These reasons are legitimate, provided you bear in mind that the technique changes neither the consolidation period, nor the work on the tip, nor the need to wait a year to judge the result.

Let us summarise the questions to ask yourself before choosing ultrasonic rhinoplasty. Does my nose involve significant bone work? Is my skin thin, so that the smoothness of the bridge will matter a great deal? Does the practitioner use the technique regularly, and for which steps? Is the extra cost clearly stated and justified in my case? Have I understood that the tip and breathing depend on other steps? Am I prepared to wait a year to judge the result? If you answer yes to most of these questions, the technique may be a good choice for you.

Budget

Price differences between cities and cantons, the quote breakdown and ways to save are detailed on our page Ultrasonic rhinoplasty: prices in Switzerland.

Related procedures

• Septoplasty in Switzerland
• Ethnic rhinoplasty in Switzerland
• Endotine endoscopic lift in Switzerland
• Brow and temporal-midface lift in Switzerland
• Blepharoplasty in Switzerland

Combined procedures

• Rhinoplasty and buccal fat removal in Switzerland
• Rhinoplasty and genioplasty in Switzerland
• Profileplasty: nose, chin and double chin in Switzerland

Our guides

• Rhinoplasty in Switzerland
• Cosmetic surgery in Switzerland

Answers to the questions most often asked by patients living in Switzerland about ultrasonic rhinoplasty. For general questions about nose surgery, see also our page on rhinoplasty in Switzerland.

The instrument and the technique

What is ultrasonic rhinoplasty? It is a rhinoplasty in which the work on the nasal bones is carried out with a piezoelectric device whose tip vibrates at ultrasonic frequency. It is used to lower a bony hump, perform osteotomies and sculpt the bony walls, instead of chisels struck with a mallet and manual rasps. The rest of the procedure, particularly the work on the cartilage and tip, is identical to a conventional rhinoplasty. It is also called piezo rhinoplasty. The term therefore refers to a tool, not to a particular nose shape.

What is piezosurgery? It is a surgical technique that uses the piezoelectric effect: certain materials deform very rapidly under the effect of an alternating electric current. These micro-vibrations, transmitted to a metal tip, make it possible to cut bone precisely and selectively. It was used for a long time in dental and maxillofacial surgery before being applied to the nose. In the nose, this advantage is valuable, as the bone is surrounded by mucous membrane, small blood vessels and sensory nerves over a very small area.

Why is it called selective cutting? Because the vibration acts effectively on hard, mineralised tissues such as bone, while soft, elastic tissues such as blood vessels, nerves or mucous membrane move with it and are largely spared. This selectivity is not absolute: prolonged, firm contact can injure soft tissues. That is why the surgeon keeps the insert moving and withdraws it regularly, rather than pressing it in the same place for a long time.

Do ultrasonic instruments cut cartilage? Not effectively. Cartilage is soft and absorbs the vibration. That is why the tip, the cartilage of the middle third and the cartilaginous part of the septum are always worked on with the usual instruments: scalpel, scissors, sutures. This limitation explains why the technique mainly concerns the upper third of the nose, the bony pyramid.

What is the difference from a conventional osteotome? The osteotome is a chisel that the surgeon strikes with a small mallet to fracture the bone in a controlled way. The ultrasonic instrument cuts the bone gradually, without percussion, following exactly the desired line. It avoids irregular fractures and allows symmetry to be checked at each stage. The difference is comparable to that between a blow with a chisel and a line drawn with a fine file: the movement is slower, but better controlled.

What is an insert? It is the interchangeable tip attached to the device's handpiece. There are several shapes: rasps of different coarseness for lowering and smoothing, fine saws for osteotomies, and finishing tips. The surgeon changes them during the procedure. Depending on the model, inserts are sterilised or single-use, which contributes to the cost of the technique.

Why is irrigation needed? The vibration produces heat on contact with the bone. A sterile fluid sprayed continuously cools the area, prevents thermal injury, removes bone debris and improves visibility. The fluid is suctioned away as it goes, allowing the surgeon to keep a clear view of the bone.

What is rhinosculpture? It is the term sometimes used to describe the gradual shaping of bone with ultrasonic inserts, rather than fracturing and repositioning. The surgeon lowers the hump and refines the walls in small touches, monitoring profile and symmetry. This approach takes time, but allows the shape to be adjusted millimetre by millimetre.

Is ultrasonic rhinoplasty a recent technique? Its application to the nose developed in the 2010s, based on technology already long established in oral and jaw surgery. It has a track record of more than a decade and a growing body of medical literature. Practitioners who have been using it for several years have built up solid experience of its indications and limitations.

Is an open approach always necessary? For extensive use, with sculpting of the hump and osteotomies under direct vision, most surgeons prefer the open approach, which widely exposes the bone. More limited steps, such as some osteotomies, can be performed through the closed approach with suitable inserts. The surgeon will explain their choice according to the extent of the planned bone work.

Why is the skin lifted more widely? To use the inserts while seeing the bone precisely, the surgeon lifts the skin and periosteum over the whole bony pyramid. This wider undermining is the price of precision; it can prolong swelling of the bridge of the nose. This undermining follows the plane directly on the bone, beneath the periosteum, which bleeds little.

Do ultrasonic instruments completely replace conventional instruments? No. They replace conventional instruments for bone work, but not for cartilage work, the cartilaginous septum or the tip. Some surgeons even combine both approaches for the bone, depending on the step. This combination allows each structure to be treated with the most suitable tool.

Is the technique compatible with preservation rhinoplasty? Yes, and the two are often combined. In some variants of preservation, the bridge is lowered by removing a strip of bone at the base of the nasal pyramid; ultrasonic inserts allow these precise cuts. This combination preserves the natural line of the bridge while lowering it precisely.

Do ultrasonic instruments make a noise? The device emits a high-pitched sound while operating, but you are under general anaesthesia and do not hear it. Unlike conventional instruments, there are no mallet blows. For the theatre staff, the absence of percussion also makes the procedure quieter.

Do all surgeons who advertise ultrasonic rhinoplasty use it in the same way? No. Some use it only for osteotomies, others for all the bone work. Ask precisely which steps will be performed with the device. A detailed quote should specify these steps, allowing you to compare genuinely equivalent offers.

Is the device regulated in Switzerland? Medical devices used in Switzerland must comply with Swiss regulations, under the supervision of Swissmedic. The practitioner can tell you which device they use. Inserts and generators used in surgery are medical devices subject to conformity requirements.

Does the technique change the shape of the nose obtained? It does not change the aim, which is defined with the surgeon. It can improve the smoothness of the bony contours and the symmetry of the narrowing, which matters especially in patients with thin skin. The final shape always depends on the agreed plan, your tissues and healing.

Are ultrasonic instruments used on the septum? Sometimes, for the deep bony part of the septum, particularly when a bony spur impairs breathing. The cartilaginous part is treated conventionally. A low bony spur on the septum that impairs breathing can thus be reduced precisely.

Can ultrasonic rhinoplasty be performed under local anaesthesia? In practice, it is almost always performed under general anaesthesia, because of the length of the procedure and the extent of undermining. The duration and undermining make general anaesthesia more comfortable for both the patient and the surgeon.

Why do some surgeons not use ultrasonic instruments? Because they achieve excellent results with conventional instruments they have fully mastered, they prefer to avoid wider undermining, or they consider the benefit limited for most of their patients. These choices are legitimate. The quality of a result depends far more on the surgeon than on the tool they hold.

Indications and choices

Does my nose need ultrasonic instruments? It depends mainly on the bony part of the work. A pronounced bony hump, a wide root or deviated bones benefit most. A rhinoplasty limited to the tip or a mainly cartilaginous hump does not necessarily need them. The surgeon will tell you after an examination. The surgeon may also use ultrasonic instruments for only some of the steps.

How can I tell whether my hump is bony or cartilaginous? By feeling the bridge of the nose, you can often feel a hard, immobile upper part, which is bone, and a slightly supple lower part, which is cartilage. The surgeon's examination and sometimes profile photos determine the proportion of each. A standardised profile photo also helps assess the height of the bony part.

Are ultrasonic instruments useful for a wide nose? Yes, when the width is bony, at the root. Ultrasonic osteotomies allow precise, symmetrical narrowing. Width due to the alae is treated differently, by alar base reduction. A front examination often shows whether the width comes from the bones, at the root, or from the alae, at the base.

Are they useful for a deviated nose? Yes, when the deviation involves the nasal bones. Controlled cutting makes it easier to reposition the fragments. The cartilaginous part of the deviation is corrected conventionally. A nose deviated since childhood may also have asymmetry of the facial bones, which cannot be fully corrected.

Are they useful for secondary rhinoplasty? They can be, to smooth bony irregularities left by a first procedure or to revise osteotomies. The rest of the revision, often cartilaginous, is treated with the usual techniques. The quality of the cartilage grafts nevertheless remains the main factor in many revisions.

Are they suitable for thin skin? This is one of their best indications: on thin skin, the slightest bony irregularity shows, and the precision of ultrasonic sculpting is particularly valuable. Fine sculpting of the bridge is particularly visible there, for better or worse.

Are they suitable for thick skin? They can be used, but the visible benefit of bony precision is smaller, as thick skin hides detail. Work on the tip remains predominant. The structure of the tip then matters more than the refinement of the bony contours.

Are ultrasonic instruments suitable for men? Yes. In men, the bridge should remain straight and strong; gradual sculpting allows a hump to be lowered with restraint, without over-lowering. The surgeon takes care to keep a straight or slightly convex bridge, which is more natural in men.

Is there a particular age? The same rules as for any rhinoplasty apply: growth complete, generally after sixteen or seventeen. In older people, with thinner bones, precise cutting can be an advantage. In older patients, thinner bones may fracture less predictably with an osteotome.

Do ultrasonic instruments make the procedure less invasive? Not in the sense of a smaller procedure: undermining is often wider. They are less traumatic for the soft tissues next to the bone, which can reduce bruising. The procedure remains genuine surgery, with its after-effects and precautions.

Can I ask for ultrasonic instruments if my surgeon does not offer them? You can discuss it, but it is better to be operated on with the technique the surgeon has mastered best. If the technique seems important to you, consult a practitioner who uses it regularly. A surgeon who uses a tool occasionally rarely obtains better results than with their usual instruments.

Does the technique change insurance coverage? No. The rules remain the same: the documented functional part may be covered by insurance, the cosmetic part may not. The use of ultrasonic instruments for the cosmetic part remains at your expense. Only the documented functional part, such as correction of the septum, can be the subject of a coverage request.

Can genioplasty be combined? Yes. Ultrasonic rhinoplasty can be combined with genioplasty to harmonise the profile. See our page on rhinoplasty and genioplasty. The two procedures complement each other: the nose is refined, the chin projected, and the profile gains balance.

Are any particular tests needed beforehand? There is no test specific to the technique. The work-up is that of a rhinoplasty: examination of the nose, assessment of breathing, and a pre-operative check-up depending on age and medical history. A CT scan may be requested for a complex deviation or a sinus problem. An assessment of breathing is always part of the consultation.

Are ultrasonic instruments suitable after a recent fracture? For a recent fracture, simple reduction in the first few days is often enough. Ultrasonic rhinoplasty can be considered later to correct bony after-effects. The after-effects of an old fracture, with poorly healed bones, can however be well suited to the technique.

Can I have an ultrasonic rhinoplasty limited to the hump? Yes, if you are happy with the tip. Ultrasonic lowering of the hump, with or without osteotomies, can form the bulk of the procedure. This shorter procedure can sometimes be performed with more limited undermining.

Are ultrasonic instruments suitable for noses with a low bridge? For a low bridge, the main step is often augmentation with cartilage grafts, not bone reduction. Ultrasonic instruments then play a limited role, possibly to refine the root. A very wide root combined with a low bridge may nevertheless benefit from precise osteotomies.

Is the technique suitable for athletes? Yes. It does not change the final strength of the bone. The same timescales for returning to contact sports apply as after a conventional rhinoplasty. For ice hockey or football players, facial protection can be discussed when returning.

Are ultrasonic instruments useful in ethnic rhinoplasty? It depends on the nose: a wide root or an irregular bony bridge may benefit, but many ethnic rhinoplasties rely mainly on cartilage strengthening. See our page on ethnic rhinoplasty. Respecting the characteristics of the face remains the priority, whatever the technique.

Can I get an opinion on whether ultrasonic instruments would help before consulting? Yes. Front, profile and three-quarter photos often make it possible to estimate the bony share of the hump and width, and therefore the value of the technique. The clinical examination will confirm this. This preliminary opinion does not replace the examination, but it usefully guides the consultation.

Procedure and recovery

How long does ultrasonic rhinoplasty take? Often a little longer than a comparable conventional rhinoplasty, generally two and a half to four hours. The extra time comes from the wider undermining and the gradual sculpting of the bone. The extra time is generally well tolerated in a patient in good health.

Will I have less bruising? It is common, but not guaranteed. Several studies report less marked bruising and eyelid swelling after ultrasonic surgery, because the blood vessels next to the bone are better spared. The extent of bruising also depends on your skin, your treatments and the extent of the osteotomies. Reduced bruising is the benefit most often reported by patients.

Will the swelling be less? Swelling around the eyes is often less in the first few days. The bridge of the nose, however, may stay a little more swollen, because of the wider undermining. The tip follows its own timetable, as with any rhinoplasty. Cold, keeping the head raised and rest remain the best ways to limit swelling.

Is recovery faster? You often look presentable a little sooner, thanks to less marked bruising. But consolidation of the bones, reduction of tip swelling and the final result follow the same timescales as after a conventional rhinoplasty. Do not confuse "presentable" with "consolidated": the precautions remain the same.

How long must the splint be worn? Generally a week, as for a conventional rhinoplasty. Any internal splints are removed at the same time or slightly before. The splint protects the mobilised bones during the first few days of consolidation.

Can I wear glasses sooner? No. Even if the bruising is less marked, the mobilised bones must consolidate. Glasses must not rest on the bridge of the nose for several weeks, according to the surgeon's instructions. Contact lenses or glasses suspended from the forehead allow you to wait.

Is the pain different? It is comparable, generally moderate and well relieved by simple painkillers. The absence of percussion does not significantly change post-operative pain. Discomfort from a blocked nose and mouth breathing is often more unpleasant than the pain itself.

When can I go back to work? Often after ten to fourteen days. Less marked bruising sometimes allows you to resume work involving contact with the public a few days earlier. Working from home often allows a return from the second week.

When can I resume sport? The same timescales as after a conventional rhinoplasty apply: gentle exercise around the third or fourth week, intense sport at around six weeks, contact sports and ski goggles after two to three months. Sports with goggles, such as skiing, have to wait until the bones have fully consolidated.

When is the result final? The profile becomes defined within a few months, but the final result, particularly the tip, is assessed at around twelve to eighteen months, as with any rhinoplasty. Photos at one year allow the result to be judged objectively.

Will the bridge of the nose be smoother? That is one of the aims of the technique. Gradual sculpting and fine finishing aim for a smooth bony bridge, without steps or irregularities, which are particularly visible on thin skin. On thin skin, this smoothness is particularly appreciated.

Are the bones stronger afterwards? Consolidated bones are as strong as after a conventional rhinoplasty. Precise cuts can make stable repositioning of the fragments easier. Bone consolidation follows the same timetable, whatever the cutting technique.

Is any special care needed? No, care is the same as for a rhinoplasty: saline rinses, no hard nose-blowing, head raised, protection from impacts and sun. The surgeon will give you written instructions, to be followed carefully.

Can I go home the same day? Depending on the anaesthesia, duration and the facility's practice, discharge is the same evening or the next day. You must be accompanied. A night at the clinic is often offered after a long procedure.

Is breathing better? Ultrasonic instruments do not act directly on breathing. Breathing depends on the work on the septum, turbinates and nasal valve, carried out conventionally. If there is a breathing problem, it must be treated with specific steps performed at the same time.

How many check-ups should I plan for? The same as for a rhinoplasty: splint removal at around one week, then check-ups at one, three, six and twelve months. The one-year check-up is the most important for judging the final result.

Can swelling of the bridge last longer? In some patients, yes, by a few weeks, because of the more extensive undermining. It then resolves normally. This swelling has no effect on the final result.

Can make-up resume sooner? Make-up can resume after the splint has been removed. If the bruising is less marked, there is simply less to hide. A suitable concealer is often enough to hide the last traces.

What if I still have a lot of bruising? It is possible despite the technique. It disappears within ten to fifteen days. Cold, keeping the head raised and stopping blood-thinning products beforehand limit it. Significant bruising despite ultrasonic surgery does not mean a worse result.

Will those close to me see the difference from a conventional rhinoplasty? After recovery, nothing distinguishes an ultrasonic rhinoplasty from a successful conventional rhinoplasty. The difference lies mainly in the precision of the bone work and the first few days of recovery. The difference lies mainly in comfort during the first few days and the smoothness of the bony bridge.

Risks and results

Do ultrasonic instruments reduce the risks? They can reduce certain effects, such as bruising, and limit irregular fractures. They do not eliminate the risks common to any rhinoplasty: imperfect aesthetic result, breathing problems, bleeding, infection. Patient selection and the surgeon's experience remain the main safety factors.

Are there risks specific to ultrasonic instruments? They are rare: overheating if irrigation is insufficient, soft tissue injury with prolonged contact, slightly longer-lasting swelling of the bridge. The surgeon's experience is the main safety factor. These risks are rare and should be discussed at the consultation.

Can there be a burn? In theory, thermal injury is possible if the insert heats up without sufficient cooling. Continuous irrigation and short passes make this risk very low. Report any unusual redness or blistering on the skin of the nose immediately.

Is the aesthetic result better? The available studies do not show systematic superiority of the final result at one year. The benefit lies mainly in bony precision and the immediate after-effects. The result depends above all on planning and work on the cartilage. The benefit of the technique therefore lies more in the journey than in the destination.

Are touch-ups less frequent? It has not been shown that touch-ups are less frequent overall. Bony irregularities may be, but many touch-ups concern the tip, which is not affected by ultrasonic instruments. Choosing a surgeon experienced in rhinoplasty remains the best way to limit touch-ups.

Can the technique fail? The instrument may not suit some very thick bones or certain situations; the surgeon can then complete the work with conventional instruments. This does not compromise the procedure. The patient generally suffers no consequences.

Can ultrasonic instruments damage the mucous membrane? Prolonged contact can injure the mucous membrane. The surgeon protects it and limits contact time. A small injury generally heals without consequence. The nasal mucous membrane heals quickly and well in the vast majority of cases.

Is there a risk to the eyes? Osteotomies are performed at a distance from the eyes. The risk of eye injury is exceptional, as in conventional rhinoplasty. A drop in vision after the procedure nevertheless requires immediate medical attention. Both conventional and ultrasonic osteotomies maintain a safe distance from the eye socket.

Can the nose remain irregular? A small irregularity is possible, as after any rhinoplasty, but fine sculpting is designed precisely to limit it. An irregularity persisting at one year can be touched up. The small incision of the open approach makes a targeted touch-up easier if necessary.

Can there be asymmetry? Asymmetrical swelling is common at first. Lasting asymmetry is possible, but the precision of the osteotomies aims to reduce it. Asymmetry due to swelling generally corrects itself in the first few months.

Are ultrasonic instruments riskier for smokers? Smoking increases the risks of any rhinoplasty, particularly for the undermined skin, which is more extensive with ultrasonic surgery. Stopping is strongly recommended. Stopping smoking also improves the quality of healing of the skin of the nose.

Do I need to stop certain medicines? Yes, as for any surgery: products that encourage bleeding are suspended on medical advice. Anticoagulants are managed with the prescribing doctor. Never change a prescribed treatment without medical advice.

Which signs should alert me? Heavy bleeding, fever, increasing pain, painful blockage on one side, reduced vision. Contact the team without delay; in an emergency, call 144. Keep the practice's number to hand during the first few weeks.

Is the result lasting? Yes. The changes to the bone are permanent. The nose then ages like the rest of the face. Regular sun protection preserves the quality of the skin of the nose over time.

Are ultrasonic instruments suitable if I have coagulation disorders? Coagulation disorders must be assessed before any rhinoplasty. The preservation of blood vessels by ultrasonic instruments is an advantage, but does not replace appropriate medical management. A prior specialist opinion is then essential.

Is infection more frequent? There is no evidence of an increased risk of infection. Infection remains rare and is treated with antibiotics. Aseptic protocols and the nose's good blood supply limit this risk.

What if I am not satisfied? Wait until one year, as swelling is deceptive. Then discuss a possible touch-up with the surgeon, specifying what bothers you. Reference photos taken before the procedure make this discussion easier.

Does ultrasonic surgery make future revision more difficult? No. A later procedure remains possible; the operative report will show what was done. The operative report will be invaluable to the surgeon performing any revision.

Does sensation in the nose return? Yes, gradually, over a few weeks to a few months, as after any rhinoplasty. Tingling often accompanies the return of sensation.

Who should perform ultrasonic rhinoplasty? A plastic surgeon or an ENT specialist trained in facial surgery who regularly performs rhinoplasty and uses the device routinely. Check their title in the MedReg register. Regular use of the device counts for more than simply owning one.

Organising your procedure in Switzerland

Where can I have ultrasonic rhinoplasty in Switzerland? Mainly in the major cities: Zurich offers the widest choice, followed by Geneva, Lausanne, Basel and Bern. Lucerne, St. Gallen and Lugano have a few equipped practitioners. Always check with the practitioner. A photo-based pre-assessment helps you find out whether the technique is relevant for you.

How much does ultrasonic rhinoplasty cost? There is no official fee. Using ultrasonic instruments generally adds a few per cent to a quarter of the price of a comparable conventional rhinoplasty, depending on the extent of their use. Our price page details these differences by city. Compare complete quotes for equivalent procedures.

Is the extra cost justified? It is if your nose requires significant bone work, where precision and reduced bruising bring a real benefit. For a rhinoplasty limited to the tip, it is not. For a nose requiring limited bone work, a well-performed conventional rhinoplasty is often enough.

Does LAMal reimburse the technique? Not for the cosmetic part. If a functional correction is covered, it is covered under the usual rules, regardless of the instrument. A prior cost approval request remains necessary for the functional part.

I live far from an equipped centre: what should I do? Have a photo-based pre-assessment to find out whether the technique is useful in your case. If so, consult in the nearest major centre and plan the journey for splint removal, around the seventh day. The splint removal check-up, around the seventh day, is the appointment not to miss.

Should I compare several practitioners? It is advisable, comparing not only the use of ultrasonic instruments but above all the analysis of your nose, the proposed simulation and the importance given to breathing. Write down the answers after each consultation so you can compare with a clear head.

What should the quote specify? It should state that ultrasonic instruments will be used and for which steps, the approach, functional and cosmetic procedures distinguished, any grafts, anaesthesia, clinic and equipment costs, check-ups and VAT. A quote that does not mention ultrasonic instruments does not tell you whether they will be used.

How many days off should I plan for? Generally ten to fourteen days. The possible reduction in bruising sometimes allows you to return to work involving contact with the public a little sooner. For a covered functional part, a certificate of incapacity for work can be issued under the usual rules.

What is the best time of year? As for any rhinoplasty, autumn and spring are popular; avoid the pollen season if you have allergies, and winter if you do not want to give up skiing. Autumn remains the most popular period; book ahead.

Can my family doctor help me? Yes, for the pre-operative check-up, managing your treatments, monitoring rinsing and breathing, and as a point of contact if you have any doubts. Give them a copy of the operative report.

Can I be followed up in my own language? Equipped practitioners are found in all three main language regions, and many also consult in English. State your preferred language when booking your appointment.

Are waiting times longer? As practitioners who use ultrasonic instruments are often in great demand, waiting times can be several weeks for a consultation. Plan ahead. University holiday periods are particularly popular.

What should I prepare at home? Pillows to sleep with your head raised, cold compresses, saline solution, a humidifier, soft tissues, easy-to-eat food and, if you wear glasses, a temporary solution. If you wear glasses, arrange a temporary solution before the procedure.

Do I need someone with me? Yes, for the journey home and ideally for the first night. Also organise the journey for splint removal, about a week later.

Which documents should I keep? The operative report, which specifies the steps performed with ultrasonic instruments, prescriptions, instructions and the invoice. These documents will be useful in the event of a touch-up.

Can other procedures be combined? Yes: genioplasty, buccal fat removal, double chin treatment, blepharoplasty. The surgeon assesses whether the combination is reasonable. The surgeon assesses whether the combination is reasonable for your health and the total duration.

Is the technique available in Ticino? A few practitioners in Lugano use it. Ticino patients can also consult north of the Alps, particularly in Zurich. Consultations in Lugano are held in Italian.

Can I see the device at the consultation? Some practitioners are happy to show their equipment and inserts. Do not hesitate to ask if it reassures you. This openness is often a good sign of mastery of the technique.

How should I prepare my photos for an opinion? Take a front view, two profiles, two three-quarter views and a view from below, in natural light, without filters. Say whether you can feel a hard hump at the top of your nose and whether you have had an injury. Avoid filters and retouching, which distort the analysis.

How can I get a personalised opinion? Fill in the form on this page with your photos and medical history. A practitioner tells you whether ultrasonic instruments would be useful for your nose, which approach would be considered and what budget to plan for. Free and without obligation. You generally receive a reply within twenty-four hours of receipt of a complete file.

Send us photographs — front, profile, three-quarter views and from below, in natural light — together with your medical history. A practitioner tells you whether ultrasonic instruments would be useful for your nose, which approach would be considered and what budget to plan for. Free, no obligation, no administration fees.