Ultrasonic (piezoelectric) rhinoplasty in Madrid: cosmetic and functional

In ultrasonic (or piezoelectric) rhinoplasty, the bones of the nose are cut and reduced with an instrument that vibrates ultrasonically, instead of with osteotomes and a mallet [1][2]. It can be done for cosmetic or functional reasons, or both: to change the shape of the nose and, at the same time, to make sure it breathes well inside.

Dr. Méndez-Benegassi is an ENT (ear, nose and throat) surgeon who also works on snoring and sleep apnea. He performs ultrasonic rhinoplasty, both cosmetic and functional, as well as septum and turbinate surgery. This page explains what the studies say, including what ultrasound does not change.

You may have looked for it as a septorhinoplasty: it is the same operation with the two words joined — rhinoplasty, the shape on the outside, plus septoplasty, the septum on the inside. In his operations the cosmetic part and the septum are done at the same time, not in two goes.

What is ultrasonic rhinoplasty and how does it differ from the classic technique?

What changes is the tool used to cut the bone: in the classic technique, osteotomes and rasps; in the ultrasonic one, a piezoelectric instrument that vibrates. In clinical trials this meant less swelling, less bruising and less pain in the first week [1][2].

The instrument is designed to act selectively on bone through ultrasonic micro-vibrations: in clinical trials it did not damage the lining inside the nose in any case [1]. The cartilage — the tip, the nostrils and the lower part of the bridge — is not worked with ultrasound.

Dr. Méndez-Benegassi also uses the optical microscope in nasal surgery: it magnifies and lights the area being worked on inside the nose, which is narrow and poorly lit. It is a way of seeing, not a different operation, and on its own it does not guarantee a better result.

Precision bone and cartilage shaping: ultrasound, micro-cutting and diamond burr

For optimal refinements, we combine selective ultrasonic micro-vibrations for bone with millimetric precision cartilage cutting and fine filing with a diamond burr. This combination achieves the most accurate adjustments in both the bony and cartilaginous framework, delicately smoothing transitions and preventing palpable steps or sharp edges.

What the studies compared: ultrasound versus the classic technique

The authors of one of the meta-analyses describe this evidence as weak, because of the low quality of the studies [2]. Both techniques are valid; what is decided in each case is what that particular nose needs.

What can be changed in a cosmetic rhinoplasty?

The usual reasons are a hump, a drooping or wide tip and a crooked nose. The bony part of the hump and the width of the nasal bones are worked with ultrasound; the tip is cartilage and is shaped with other techniques. Before surgery, you agree what to change.

Seeing it first: the simulation in the consulting room, at no cost

At the consultation, we perform a simulation on your photographs to study your case, at no added cost. This tool allows you to visualize feasible changes and align expectations: understanding which modifications are viable and which are neither advisable nor achievable before planning the surgery.

It is not a promise or a fixed picture of the final result: it is an orientative planning guide. The nose continues healing over months—by the first month about two-thirds of the swelling subsides, and the definitive result is not evaluated until one year later [18].

Hump on the bridge of the nose

The hump has a bony part at the top and a cartilage part below (see the plate above). There are two ways of dealing with it: reducing it (structural technique) or lowering the whole bridge while keeping its surface (preservation rhinoplasty). In a meta-analysis of 10 studies, preservation left fewer irregularities on the bridge, but the hump remained or came back more often; breathing was the same with both [5]. In another meta-analysis of 22 studies, the hump came back in about 4 out of 100 people after preservation [6]. The choice depends on each nose.

Drooping, wide or bulbous tip

The nasal tip is formed by the alar cartilages, not by bone, so ultrasound does not act directly upon it: it is sculpted using structural cartilage techniques. In a series of 369 cosmetic rhinoplasties, not addressing the tip in the first operation was associated with higher dissatisfaction [7]. That is why tip architecture is planned alongside the bridge, even when your primary concern is a dorsal hump.

Crooked nose

A nose can be crooked on the outside (bones and cartilage), on the inside (the septum) or both. When the septum is straightened and the outer parts are also moved to make the nose more symmetrical, the operation is called a septorhinoplasty [24]; we explain it in functional septorhinoplasty (functional rhinoplasty). If only the septum is deviated, the operation is a septoplasty.

Structure, support and profile: septal, rib, ear and polycaprolactone grafts

To obtain the best nasal framework, stable tip support and an optimal profile, grafts are chosen according to the structural needs of each case. We use autologous cartilage from the septum, costal cartilage (rib) or auricular cartilage (ear), as well as biocompatible polycaprolactone (PCL) scaffolds: these polycaprolactone grafts reabsorb over time, being replaced by the patient’s own natural collagen to maintain structural support permanently and biologically.

Uniform dorsal contour: customized cartilage pâté technique to prevent irregularities

To prevent dorsal irregularities or visible edges as tissues heal over time, we use a customized cartilage pâté technique (finely diced autologous cartilage). This biological matrix is placed over the dorsal framework to soften transitions, camouflage micro-defects and achieve a seamless, natural contour. The same cartilage, on its own, is used as a permanent nose filler instead of hyaluronic acid.

What is the nasal valve, and what are spreader grafts?

The nasal valve is the narrowest part of the whole nose, and all the air you breathe goes through it. Spreader grafts are two thin strips of cartilage placed there to support it when the bridge is lowered. In 17 rhinoplasty studies obstruction fell by 23.9 points out of 100 after surgery, although the review itself found no difference between using a graft and using none [25].

When a hump is removed, the roof of the nose is left open and has to be closed again. If that area ends up narrower than it was, the valve collapses when you breathe in hard and less air gets through: a nose operated on only to make it smaller can end up breathing worse than before. Insufficient support of that part of the nose during a rhinoplasty can cause significant complications, which is why it is looked after [26]. That is also why the outside and the inside are planned together; among 100 people having a second nose operation, 65 complained that they could not breathe well [9].

The grafts are two thin strips of the person’s own cartilage — usually taken from the septum — placed one on each side of the septum, just under the bridge, to open that angle again and support the roof. In a systematic review of 52 studies, the 17 that measured the NOSE questionnaire found obstruction fell by an average of 23.9 points out of 100 after the rhinoplasty (95% confidence interval: 21.1 to 26.7) [25]. That figure is smaller than the 43 to 50 points of nasal valve surgery [8] because here every kind of rhinoplasty is measured, not only noses that breathed badly before the operation.

The same review warns that the studies were very different from one another and that, with the data available, it found no significant difference between using a spreader graft and using none [25]: what is decided in each nose is whether that area needs support, not that the graft on its own improves breathing. There is also a variant that adds no cartilage and instead folds the person’s own lateral cartilage inwards (spreader flap): in a meta-analysis of 10 studies and 567 patients, both gave the same result for breathing and for the lines of the bridge, although patients with the graft were somewhat more satisfied with the appearance [26].

Not every rhinoplasty needs them: it is decided nose by nose, depending on how the valve is and what has to be done with the bridge. It is one of the things examined before surgery.

ENT surgeon or plastic surgeon: who performs a rhinoplasty?

Both specialties are trained to operate on the nose, and both include surgeons with experience in rhinoplasty. What an ENT surgeon brings is knowledge of the inside of the nose and of the airway: the septum, the turbinates, the nasal valve and, in this case, snoring and sleep apnea.

Historically, a divide existed: classic plastic surgery often approached the nose from an external aesthetic viewpoint, while traditional ENT focused solely on straightening the internal septum without addressing the external dorsum or tip. However, the nose cannot be separated into two disconnected halves: reducing a hump or narrowing the middle vault without reconstructing the internal nasal valve can leave a patient breathing worse than before (in published series, 65 out of 100 people undergoing revision rhinoplasty complained of breathing difficulties [9]).

The modern international standard is represented by Facial Plastic Surgery: a discipline where the surgeon integrates deep knowledge of nasal ventilation and mucosal endoscopy with advanced aesthetic proportions and osteocartilaginous sculpting.

Dr. Méndez-Benegassi: Merging Airway and Facial Aesthetics

Dr. Méndez-Benegassi combines both areas in his surgical practice: he is a specialist in Otorhinolaryngology and Head & Neck Surgery (SEORL-CCC), a member of the European Academy of Facial Plastic Surgery (EAFPS) —the leading European scientific society dedicated to nasal and facial plastic surgery— and a member of the Spanish Society of Aesthetic Medicine (SEME), holding a Master’s Degree in Facial Aesthetics with Honors (Universidad Complutense de Madrid). This way, breathing, care of the nasal lining and facial balance are planned and operated on together with high-resolution microscopy and piezoelectric ultrasound.

Consultations and clinical evaluations are held at HM Madrid, HM Valdebebas, and HM Tres Cantos, including in-clinic photographic simulation without added cost.

Certified Credentials & Memberships

Accredited Memberships & Scientific Societies

Dr. Méndez-Benegassi brings together the three essential pillars for advanced rhinoplasty: functional airway surgery, European facial plastic surgery, and facial aesthetic medicine.

SEORL-CCC

Spanish Society of Otorhinolaryngology and Head & Neck Surgery

ENT Specialist · Airway, Valve & Functional Septum

Official ENT Society in Spain→

EAFPS

European Academy of Facial Plastic Surgery

Active Member · European Facial Plastic & Reconstructive Surgery

European Benchmark in Rhinoplasty & Facial Plastic Surgery→

SEME

Spanish Society of Aesthetic Medicine

Full Member · Master's with Honors in Facial Aesthetics (UCM)

Facial Proportions, Aesthetics & Facial Balance→

Whoever you choose, it helps to ask the same questions: what can and cannot change in your nose, how your breathing will be checked before and after, and what recovery to expect.

What is recovery like, week by week?

Bruising around the eyes usually lasts a few days [24], and it is in that first week that ultrasound makes a difference [1]. The swelling you cannot see takes longer: about two-thirds goes in the first month and the rest, little by little, over the rest of the first year [18].

First days

The nose is a little sore; the discomfort is managed with simple painkillers [24]. A small splint is usually placed on the outside of the nose to hold the bones while they heal [24]. Bruising around the eyes is common; with ultrasound it was less on days 1, 2 and 7 [1].

Two weeks

In a study of 110 people operated on with ultrasound, by day 14 the swelling around the eyes had gone and bruising was minimal [17]. When to go back to work depends on your job and on what was done; your surgeon will tell you.

First month

About two-thirds of the swelling has gone [18].

Six months

Around 95% of the swelling has gone [18]: most of the change can already be seen.

One year

Around 97.5% [18]: this is when the final result is assessed. In 17 studies, satisfaction with the nose (ROE questionnaire, 0 to 100) averaged 33.5 before surgery, 69.6 in the first six months and 80.25 at one year [19].

This is what the studies and guidelines describe; your surgeon will give you the instructions for your case. For surgery in general, see recovering from sleep apnea surgery.

Is nasal packing used after a rhinoplasty?

In most cases, no. Dr. Méndez-Benegassi avoids the classic packing and uses biodegradable materials or stitches. In septum surgery, trials show that full nasal packing causes more discomfort and does not prevent bleeding [20]. There are fewer studies in septorhinoplasty: in one trial, devices that let air through were more comfortable than packing [21].

In a meta-analysis of 47 trials in septum surgery, packing caused more difficulty breathing, pain and poor sleep, without reducing bleeding; stitches through the septum were an alternative with fewer problems [20]. If packing or splints are needed in your case, your surgeon will tell you for how long.

What are the risks, and how often is a revision needed?

Serious complications are uncommon: in 4,978 cosmetic rhinoplasties, 0.7% needed emergency care, admission or another operation in the first month, mainly for a blood collection (haematoma) or infection [22]. Having another operation is more common: depending on the series, between 2 and 10 out of 100 people [7][23].

• Who has more risk: in that same series, complications were more frequent from the age of 40 and when the rhinoplasty was combined with other cosmetic operations [22].
• Hump: it can remain or come back, more often with preservation rhinoplasty [5][6].
• Breathing: in many second operations, one of the complaints is not being able to breathe well [9]; that is why breathing is assessed before the first one.
• Satisfaction: in a series of 369 cosmetic rhinoplasties, 15.4% were not satisfied [7]. Talking through expectations beforehand is part of the operation.

Consultations and clinical evaluations are held at HM Madrid, HM Tres Cantos, and HM Valdebebas, with maximum hospital safety guarantees, optical microscopy, and advanced surgical equipment.