I'll avoid making this post too technical and boring. Simply speaking, piezosurgery is a technique which first came out of Europe (Italy), and utilizes ultrasonic energy to manipulate bones. The technique is completely atraumatic to soft tissue (skin, fat, muscle, cartilage), and will selectively manipulate only bone. Thus, piezosurgery techniques are directed toward the upper third of the nose, which is mostly bone (ie, humps, bumps, crookedness).
 

Have you noticed how certain stars have seemingly flawless skin and very high-arched brows? Cindy Crawford and Halle Berry are notable examples. The question is always asked, is that the gift of pleasant genetics alone, or is there some help from Botox? (Although Cindy Crawford has admitted to the benefits of Botox enhancement.)

Until about two years ago I viewed elective surgical reshaping of the neck differently than I do now. Then, I thought of the neck lift operation as something that should or should not accompany a face lift operation. Now, I view the neck quite differently. In many ways, I often find myself assessing whether a face lift should accompany the neck lift operation.

Part of what makes rhinoplasty such a tremendously interesting surgical procedure, is that there exists an interrelated geometry and physics among the various structures of the nose. That is, no isolated anatomic structure can be assessed, or certainly manipulated, without consideration of other anatomic structures. Each anatomic element of the nose exists in relation to the others, and maintaining a balance among the elements is the beautiful symphony that is rhinoplasty.

The use of Botox® Cosmetic as a neuromodulator to treat hyperfunctional lines helped spark a cosmetic revolution with regard to minimally invasive approaches to creating a youthful appearance. However, in the early years, while creating a more “youthful” look, practitioners were not always yielding a very “natural” look. Often patients were treated to the endpoint of having a totally immobile upper face while the medicine was working. Adding to this, patients were requesting this look and complaining if even a hint of muscle movement was evident at the site of injection.

Beauty of the face remains a complex and arguable concept. The paradigm of our understanding and appreciation of the beautiful face has changed. As facial plastic surgeons, we have abandoned such techniques that “pull tightly” and “make tiny” and “keep thin.” In so doing, the pendulum has swung far the opposite way, and we have more recently embraced concepts of volume enhancement, tissue preservation, and minimally invasive techniques.