European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 2, pp 861–865 | Cite as

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty

  • Ümit Taşkın
  • Timur Batmaz
  • Mehmet Erdil
  • Salih Aydın
  • Kadir Yücebaş


The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.


Rhinoplasty Osteotomy Edema Ecchymosis 


Compliance with ethical standards


There is no financial support or funding.

Conflict of interest



  1. 1.
    Thomas JR, Griner NR, Remmler DJ (1987) Steps for a safer method of osteotomies in rhinoplasty. Laryngoscope 97(6):746–747CrossRefPubMedGoogle Scholar
  2. 2.
    Parkes ML, Kamer F, Morgan WR (1977) Double lateral osteotomy in rhinoplasty. Arch Otolaryngol 103(6):344–348CrossRefPubMedGoogle Scholar
  3. 3.
    Chu E, Davis RE (2015) SMAS debulking for management of the thick-skinned nose. JAMA Fac Plast Surg 17(4):305–306CrossRefGoogle Scholar
  4. 4.
    Arslan E, Gencel E, Pekedis O (2012) Reverse nasal SMAS-perichondrium flap to avoid supratip deformity in rhinoplasty. Aesthet Plast Surg 36(2):271–277CrossRefGoogle Scholar
  5. 5.
    Rees TD (1971) An aid to the treatment of supratip swelling after rhinoplasty. Laryngoscope 81(2):308–311CrossRefPubMedGoogle Scholar
  6. 6.
    Vega-Villasante P, Covarrubias H (1995) A new splint for the nasal tip. Plast Reconstr Surg 96(1):189–193CrossRefPubMedGoogle Scholar
  7. 7.
    Tosun F, Arslan HH, Hidir Y, Karslioglu Y, Durmaz A, Gerek M (2012) Subcutaneous approximation suture for preventing soft tissue pollybeak deformity. Am J Rhinol Allergy 26(4):e111–e114CrossRefPubMedGoogle Scholar
  8. 8.
    Gerbault O, Daniel RK, Kosins AM (2016) The role of piezoelectric instrumentation in rhinoplasty surgery. Aesthet Surg J 36(1):21–34CrossRefPubMedGoogle Scholar
  9. 9.
    Kara CO, Gökalan I (1999) Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plast Reconstr Surg 104(7):2213–2218CrossRefPubMedGoogle Scholar
  10. 10.
    Caglar E, Celebi S, Topak M, Develioglu NO, Yalcin E, Kulekci M (2016) How can periorbital oedema and ecchymose be reduced in rhinoplasty? Eur Arch Otorhinolaryngol 273(9):2549–2554CrossRefPubMedGoogle Scholar
  11. 11.
    Taskin U, Yigit O, Bilici S, Kuvat SV, Sisman AS, Celebi S (2011) Efficacy of the combination of intraoperative cold saline-soaked gauze compression and corticosteroids on rhinoplasty morbidity. Otolaryngol Head Neck Surg 144(5):698–702CrossRefPubMedGoogle Scholar
  12. 12.
    Sinha V, Gupta D, More Y, Prajapati B, Kedia BK, Singh SN (2007) External vs. internal osteotomy in rhinoplasty. Indian J Otolaryngol Head Neck Surg 59(1):9–12CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Huizing EH (2004) Functional reconstructive nasal surgery. J Cranio-Maxillofac Surg 32(4):260CrossRefGoogle Scholar
  14. 14.
    Kara CO, Kara IG, Topuz B (2005) Does creating a subperiosteal tunnel influence the periosteal edema and ecchymosis in rhinoplasty? J Oral Maxillofac Surg 63:1088–1090CrossRefPubMedGoogle Scholar
  15. 15.
    Kuran I, Özcan H, Usta A, Bas L (1996) Comparison of four different types of osteotomes for lateral osteotomy: a cadaver study. Aesthet Plast Surg 20(4):323–326CrossRefGoogle Scholar
  16. 16.
    Harshbarger RJ, Sullivan PK (1999) Lateral nasal osteotomies: implications of bony thickness on fracture patterns. Ann Plast Surg 42(4):365–370 (discussion 370-371) CrossRefPubMedGoogle Scholar
  17. 17.
    Nolst Trenité GJ (1991) Trauma reduction in rhinoplastic surgery. Rhinology 29(2):111–116PubMedGoogle Scholar
  18. 18.
    Ilhan AE, Cengiz B, Caypinar Eser B (2016) Double-blind comparison of ultrasonic and conventional osteotomy in terms of early postoperative edema and ecchymosis. Aesthet Surg J 36(4):390–401CrossRefPubMedGoogle Scholar
  19. 19.
    Al-Arfaj A, Al-Qattan M, Al-Harethy S, Al-Zahrani K (2009) Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty. J Plast Reconstr Aesthet Surg 62(11):e538–e539CrossRefPubMedGoogle Scholar
  20. 20.
    Giacomarra V, Russolo M, Arnez ZM, Tirelli G (2001) External osteotomy in rhinoplasty. Laryngoscope. 111(3):433–438CrossRefPubMedGoogle Scholar
  21. 21.
    Robiony M, Toro C, Costa F, Sembronio S, Polini F, Politi M (2007) Piezosurgery: a new method for osteotomies in rhinoplasty. J Craniofac Surg 18(5):1098–1100CrossRefPubMedGoogle Scholar
  22. 22.
    Pribitkin EA, Lavasani LS, Shindle C, Greywoode JD (2010) Sonic rhinoplasty: sculpting the nasal dorsum with the ultrasonic bone aspirator. Laryngoscope 120(8):1504–1507CrossRefPubMedGoogle Scholar
  23. 23.
    Yücel OT (2005) Which type of osteotomy for edema and ecchymosis: external or internal? Ann Plast Surg 55(6):587–590CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Ümit Taşkın
    • 1
  • Timur Batmaz
    • 2
  • Mehmet Erdil
    • 1
  • Salih Aydın
    • 1
  • Kadir Yücebaş
    • 3
  1. 1.Department of OtorhinolaryngologyBagcilar Education and Research HospitalIstanbulTurkey
  2. 2.Department of Odiometry, Medical FacultyBeykent UniversityIstanbulTurkey
  3. 3.Bağcılar Hospitalist HospitalIstanbulTurkey

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