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).
 
If I'm not using piezosurgical techniques, I'm using some combination of fine rasping, tiny chisseled osteotomes, and finely-burred drills to reshape and reposition the bones of the nose. These techniques offer great control, but they are mostly performed without looking at the bones directly (ie, the skin is overlying the bone). They are moderately traumatic to the bone or skin. By using ultrasonics (piezosurgery) to maniuplate bones, I am directly staring at my manipulation as it's being performed. Further, I have control to a level of fractions of a millimeter. Lastly, my patients experience minimal trauma at the skin level, and my post-operative swelling curves are drastically reduced. My need for post-operative nasal packing is practically none. 
 
Piezosurgical ultrasonic rhinoplasty also offers me options to reshape bones and sometimes avoid nasal fracturing altogether. When I do need to fracture the bones for distinct repositioning, I can do so leaving certain segments of the bone still attached for a very stable and precise modification. Alternatively, I can mobilize the entire segment of bone, but leave the internal lining intact (periosteum) so the bone will not collapse inward.
 
In summary, I love my piezosurgery techniques and feel very happy with my rhinoplasty results consequently. Bone manipulation is only a small segment of what ultimately gets performed during a typical rhinoplasty. Internal functional work, middle vault reconstruction for stability/symmetry/aesthetics, fine and nuanced tip work, and skin adjustments, all contribute to the aesthetically pleasing balanced nose. Rhinoplasty is a surgery designed to last a lifetime, and as with many things - every detail matters.
 
[This blog is also a part of Dr. Sparano's series "Rhinoplasty NJ".]