Our Techniques

Piezosurgery is a revolution in rhinoplasty. There is no better way to say it. For over 2 years I have been using Piezosurgery in all of my rhinoplasties, and the results for my patients has been outstanding. Popularized by myself, Dr. Rollin Daniel, and our French counterpart, Dr. Olivier Gerbault, Piezosurgery is the most disruptive technology to happen to rhinoplasty in over 20 years. Our experience has been published in the Aesthetic Surgery Journal and I have presented my experience over the last few years at the annual meetings for The Rhinoplasty Society in Montreal (2015) and Las Vegas (2016), The World Rhinoplasty Meeting in Versailles (2016), the 5th Open Bergamo Rhinoplasty Meeting in Italy (2016), and IMCAS in Paris (2017).

 

 

What is PiezoSurgery?

Piezosurgery uses ultrasonic energy (vibration) to cut hard tissues. Have you ever had a cast? When a cast comes off, it must be removed with a saw. However, the cast must be removed with sawing your arm off.  That is where ultrasonic vibration comes in. When a saw vibrates at a certain frequency it will cut hard tissues like a cast or bone without cutting soft tissue like skin.

Why is PiezoSurgery Important for the Rhinoplasty Patient?

The short answer – the bones. Many patients are terrified that a surgeon will have to “break their bones.” Standard instruments are over 100 years old and literally use a hammer and chisel to break your bones so they can be moved and narrowed. Now your bones can be gently sculpted and cut with less bruising and less swelling. It has been proven that Piezosurgery shortens recovery, and I wrote a commentary article regarding the shorter healing time.

LOOK AT THE LACK OF BRUISING/SWELLING: This photo was taken 6 days after surgery!

 

THIS IS THE SAME PATIENT 6 WEEKS AFTER SURGERY:

Why is PiezoSurgery Important for the Rhinoplasty Surgeon?

Piezosurgery is a revolution for a rhinoplasty surgeon because of the accuracy and precision of the technology. In the past, osteotomies (bone breaking) has always been done “blind,” meaning the instruments were placed under or through the skin and we could never see what was happening. Bone fractures could occur where we did not want them to and the movement was uncontrolled. With Piezosurgery, asymmetries and irregularities can be sculpted with precision and all bone cuts are visualized during surgery. This has improved my result dramatically, especially with the frontal view and dorsal aesthetic lines.

How Does this Improve Dorsal Aesthetic Lines?

Dorsal aesthetic lines are the lines of your nose that are seen on front view with flash photography. I have always said that it is the front view that separates the good rhinoplasty surgeon from the great rhinoplasty surgeon. Setting a good profile is the first step in becoming a good rhinoplasty surgeon. But getting a good front view, which makes a person more attractive, is the ultimate goal.

When woman contour their noses, they are trying to create shadows to set off the bridge from the nasal sidewalls. In surgery, I can create symmetric and fluid dorsal aesthetic lines. It has been with Piezosurgery that I can now accurately sculpt bones so smooth the transition from the forehead and brows to the nose.

Below are a few examples:

This patient presented with a crooked nose that was wide and had a bulbous tip.  With piezosurgery I was able to narrow the dorsal lines (width) and to make them uniform and straight coming down the nose.  The tip was also modified to improve the definition.

 

 

This patient presented with a wide nose and wide tip.  Using piezosurgery, the nose was narrowed by bringing in the left nasal bone in more than the right.  You will notice that before surgery the left nasal bone was farther out than the right.  Piezo instrumentation is accurate to the millimeter.


 

This patient had a very large hump.  After it was removed the nose appeared to be very wide and piezosurgery was used to narrow the nose.  Since the bridge was narrow and the tip was wide, it helped to also widen the middle third so that the upper, middle and lower third were congruent.  Lifting the tip uncrowds the lower lip and makes the nose and face much more feminine.  Before surgery we notice the nose, and after we notice the eyes!


 

This patient presented with asymmetric, developmental deviation of the nose — an asymmetric nose on an asymmetric face.  Notice the left eyebrow, ear and eye are higher on the left side.  Therefore, everything on the left side of the face is longer and narrower and everything on the right side in shorter and wider.  Piezosurgery was used to bring in the right nasal bones and to push out the left nasal bone.  With standard instruments I could never achieve the accuracy that I can with piezosurgery.

 

 

This patient presented with a bulbous tip and overall large nose.  By lifting and defining the tip, as well as narrowing the bridge, the nose and face has a much more feminine quality.  Again, notice the eyes in the photograph after surgery.

 



PlungingTipIt would be hard to find a more passionate and dedicated person to the art of rhinoplasty as myself, Aaron Kosins. In committing myself to this wonderful operation, I always continue to be a student of rhinoplasty in order to remain on the cutting edge. This is not just words on a page. Multiple times throughout the year I leave our practice to lecture internationally and to work alongside the best rhinoplasty surgeons in different countries around the world. I visit their clinics, I visit their operating rooms, and I work together to develop new ideas and techniques. In 2015 alone, papers were published through collaborative research with rhinoplasty surgeons in Hungary, France, Turkey, and Russia. By doing this, I continually pioneer new techniques and principles that will benefit you—the patient.

Patients can anticipate a rewarding plastic surgery experience with  at The Rhinoplasty Center. Depending on your needs and wishes I will recommend the most appropriate nose job procedure. Due to its high success rate, ninety percent of the rhinoplasty surgeries we perform are via the open approach, meaning a small incision is made at the base of the nose. Our signature techniques help patients enhance their nose into a natural-looking, pretty nose with appropriate shape and size.

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At The Rhinoplasty Center, the process is patient-specific, and we will either reduce, augment or define the nose depending on your ethnicity as well as desired profile. We commonly do additional procedures to enhance the nose including chin implants, neck procedures, cheek augmentation, brow lifts, etc. We take the whole face into account before performing your nose job in Newport Beach, and we will fully evaluate where and how the nose can be enhanced in relation to the rest of the individual’s face.

RhinoBrow1-700x560We have developed and teach a number of innovative techniques and concepts in rhinoplasty. For example, my mentor and partner Dr. Daniel developed a rhinoplasty technique called diced cartilage in fascia. This enormous advance in rhinoplasty was designed for those patients who require augmentation (raising) of their nasal bridge, have thin skin, or have nasal deformities from prior surgery. In addition to providing beautiful, natural-looking results, what makes this technique beneficial for the patient is that your own tissues are used. In fact, we never use artificial nasal implants. Diced cartilage in fascia means that cartilage is taken from the nose, ear or rib and is diced into small pieces and wrapped in connective tissue called fascia. This construct is then placed under the nasal skin and is incorporated immediately. Unlike nasal implants, there is no chance of rejection or extrusion and minimal risk for infection. This technique is not a gimmick or a fancy name for something that all other surgeons do. It is a technique pioneered by Dr. Daniel that is taught and used all around the world by expert surgeons.  Now that Dr. Daniel has retired, surgeons from around the US and the world come to learn this technique in my operating room.

Some of my other signature rhinoplasty enhancement techniques include the treatment of the Plunging Tip (a nose that plunges or droops on smiling), our tip suturing sequence that creates a natural yet defined nasal tip, and our treatment of the nasal radix where the nose meets the forehead. Strategically sculpting cartilage in certain areas of the nose naturally enhances the face, without the unwanted effects of a pinched, turned up or fake looking nose.

At The Rhinoplasty Center, we strongly and truly believe in maintaining a positive doctor-patient relationship, striving to provide all patients with the information they need to make the right decisions for his/her Newport Beach nose job. Individuals who are interested in learning more about rhinoplasty in Newport Beach and our nose enhancement techniques can schedule a consultation at our practice. We are very interested in understanding what you don’t like about your nose and how you would like it to be changed. After examining the outside and inside of your nose, we can begin a meaningful dialogue about how to get you the nose you have always wanted.

Published Works

Mastering Rhinoplasty - Rollin K. Daniel, MDAn Atlas of Surgical Techniques - Rollin K. Daniel. MDEndoscopic Plastic Surgery - Rollin K. Daniel. MDRhinoplasty - Rollin K. Daniel. MD