Cosmetic surgeons have a variety of tools with which to perform rhinoplasty, (cosmetic surgery of the nose). These include bone saws, carbide rasps and power-assisted rasps. However, each tool has limitations that decrease its usefulness for cosmetic surgery. For example, the tools may cause deformities, damage surrounding structures and tissue, prove difficult to use in addressing mobile bone fragments or obstruct direct visualization.

A report in the September issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals, outlines how a device known as the ultrasonic bone aspirator (which uses sound waves to remove bone without damage to surrounding soft tissue or mucous membranes) may be a useful tool for surgeons performing cosmetic rhinoplasty.

The ultrasonic aspirator was first used in dental and ophthalmological procedures, and has been used in neurosurgery since the late 1970s. Since its introduction to neurosurgery, the ultrasonic aspirator has become the tool of choice for the resection of all types of brain tumors.

Jewel D. Greywoode, M.D., and Edmund A. Pribitkin, M.D., from the Thomas Jefferson University Hospital, Philadelphia, conducted a review of 103 consecutive patients who underwent cosmetic rhinoplasty at a tertiary care academic facial plastic surgery practice.

The authors said:

“Multiple applications in nasal surgery can be found […] and although long-term results are lacking, the device’s positive safety profile and early results warrant further use and investigation.”

The ultrasonic bone aspirator was used for conventional cosmetic procedures and also in new ways for further aesthetic refinement. These included correcting deformities and sculpting mobile bone fragments.

Cartilage treated with the device was compared with untreated cartilage using histologic (microscope) analysis. Scientists looked for any injury to tissue. They recorded patient and surgeon satisfaction as well as any complications. Patients were examined at one week, one month, three months, six months and one year intervals after the procedure. The mean (average) length of follow-up was 3.2 months, with a range of zero to 14.2 months.

The most common application of the ultrasonic bone aspirator was for smoothing of the nose’s bony edges, which was performed in all patients. Outcomes were considered satisfactory for all patients. Minor complications occurred in seven patients (6.8 percent) treated with the ultrasonic bone aspirator. Injuries to skin and soft tissue were not experienced by any study participants.

It would appear that the same characteristics that make it useful for delicate operations in dentistry, ophthalmology and neurosurgery also make it ideal for cosmetic work. The authors state that the ultrasonic bone aspirator could be a useful tool for surgeons performing cosmetic rhinoplasty. The device, they explain, allows precise, graded removal of bone without damage to surrounding soft tissue or mucous membranes; can be used for procedures such as refinement of subtle irregularities and asymmetry of the nasal bones; and does not seem to have a significant risk of complications.

Written Rupert Shepherd BSc.