I was scrolling through TikTok, you know, as one does after a long day of WFH, when I stumbled upon a video that looked like a nose job. But it wasn't like any regular nose job—the doctor was using what seemed to be legit sorcery to reshape and resize his patient's nose. "WTF is this?" I texted my friend who always finds herself in a plastic surgery TikTok hole. "Whoa," she said. "No idea."
After doing a quick Google search, I discovered that it wasn't actually magic that transformed the patient's nose (shocking, I know)—it was a new technique called an ultrasonic rhinoplasty. So to learn more about the procedure, I reached out two board-certified plastic surgeons: (1) Dr. Samuel Lin, who says he chooses not to use this method and why, along with (2) Dr. Kim Patrick Murray, the doctor from the TikTok video I saw, who says he's never going back to traditional rhinoplasty ever again.
What exactly is an ultrasonic rhinoplasty?
With traditional rhinoplasty, doctors use hammers and chisels to reshape your nose. But the ultrasonic method involves reshaping the nose with an ultrasound device that "makes cuts in the bone," says Dr. Lin. As you can see in the video above, the doctor uses a hand piece—it's called a piezotome—that transfers a vibration to the nose, says Dr. Kim Patrick Murray. Because the vibration is happening so fast, you don't even really see it, which is why it's called ultrasonic.
That vibration is tuned in at a very specific frequency so that it selectively acts on bones and nothing else. So if you put it against skin or a tissue or a blood vessel, says Dr. Kim Patrick Murray, the frequency isn't high enough to cause any damage. It's kind of like a car radio when you're driving in the middle of nowhere—unless you're tuned in at the right wavelength, there's no audible sound, just white noise.
FYI: Dr. Kim Patrick Murray says the actual technology used in ultrasonic rhinoplasties isn't anything new. It was first used in brain surgery to help doctors operate on skulls and faces while trying to protect the surrounding nerves and tissues. But it only recently trickled down to rhinoplasty, he says, when the tools and attachments became small enough to use on the nose.
Why haven't I heard about it before?
A post shared by Dr. Kim Patrick Murray, MD (@dr.kimpatrickmurray) on Oct 29, 2020 at 5:40pm PDT
Well, it's pretty new. In fact, Dr. Kim Patrick Murray only heard about it being used in rhinoplasty about five years ago—and he says it probably wasn’t until two or three years ago when the tools became more available to surgeons in the US. Other than himself, Dr. Kim Patrick Murray only knows of less than five surgeons who perform ultrasonic rhinoplasties here in the states. He says part of the reason why this number is so small is because a lot of surgeons "get into a comfort zone of doing things a certain way" and that a lot of people are just comfortable using the traditional technique.
However, Dr. Lin says that one of the reasons ultrasonic nose jobs aren't commonly used at this point is because some surgeons believe there's a greater chance of post-surgical swelling with the tool—it's why he isn't 100 percent sold on the procedure. Buuuut, Dr. Kim Patrick Murray disagrees (more on that in sec).
What are the benefits of ultrasonic rhinoplasty?
With regular nose jobs, you have to use a chisel and tap at the bone, which breaks open blood vessels, causing lots of bleeding, swelling, and bruising, says Dr. Kim Patrick Murray. All of that squishy tissue around your nose is being injured, but with ultrasonic rhinoplasty, Dr. Kim Patrick Murray says the frequency of the machine protects that surrounding tissue. "There’s no bleeding, so there’s very little chance of bruising," he says. "If you use a less traumatic technique, the recovery is going to be faster." You'll still have stitches and need to wear a cast for about a week, but once it's removed, you won't have nearly as much swelling as you would with a traditional nose job.
There's also the fact that you can be way more precise with the ultrasonic method, says Dr. Patrick Murray. "Think of an ice pick—when you hit a chisel into a bone and it splinters, it can shatter in a way that you’re not expecting," he says. He also adds that with a chisel, you’re not able to get the shape of a bone perfectly smooth. Think of it like going to the nail salon, he says—it's like using only a nail clipper to get an even and consistent shape instead of an electric nail file. "With the piezotome, I can re-contour and resurface the bone in a super precise and three-dimensional way," he says.
Even though he isn't only using the piezotome during the procedure—there are other tools involved to manipulate the cartilage and cut into the skin—Dr. Kim Patrick Murray still believes the results are more consistent, the precision is much higher, and the chance of needing a revision goes way down with the ultrasonic approach. But like I mentioned before, Dr. Lin believes that patient swelling actually increases with the pietzotome device because the “amount of soft tissue work is greater.” At the end of the day, it's best to chat through your options with a surgeon you trust before making any decisions.
Who's a good candidate for ultrasonic rhinoplasty?
Complex and intricate tip reshaping in a thick skin Hispanic female. She has always disliked her nose and desired a cute, natural look. Problems I corrected during #primaryrhinoplasty: 👃🏻overprojected 👃🏻pointy tip 👃🏻bulbous large tip 👃🏻thick skin 👃🏻columellar retraction 👃🏻tip deviation to right 👃🏻wide flared nostrils 👃🏻wide nasal bones 👃🏻small dorsal hump Leave a comment and let me know how you all like this one! 👨🏻🎨 #reductionrhinoplasty #nosebykimpatrick #murraynose
A post shared by Dr. Kim Patrick Murray, MD (@dr.kimpatrickmurray) on Oct 10, 2020 at 2:49pm PDT
According to Dr. Kim Patrick Murray, everyone. "I use ultrasonic rhinoplasty on pretty much every single patient," he says. Since it's an elective surgery, you have to be healthy and have no major medical issues (like bad lung function), but besides that, it's pretty much in anyone's reach.
When I asked Dr. Kim Patrick Murray what ethnicities were most likely to visit his practice, he said that because he's based in Miami, he gets a large number of Hispanic patients. "Because the term 'Hispanic' has a pretty wide range, I see everything from more European-looking noses to more African-looking noses. Ultimately, the exact ethnic background of the individual doesn’t really matter," Dr. Kim Patrick Murray says. "Ultrasonic works on everybody who needs anything related to the bone."
Is it more expensive than a traditional rhinoplasty?
It's not that easy to compare. You see, nose jobs are like snowflakes—each one is different. So cost not only depends on where you live and what doctor you choose, but also how complex the change is, how much time it'll take, and what materials are needed, which makes Dr. Kim Patrick Murray hesitant to give a range. But according to the American Society of Plastic surgeons, a traditional nose job will cost you around $5,500, so you can use that number as a rough guesstimate.
Another thing to consider: Dr. Lin says the piezotome device isn't cheap (which is part of the reason why it hasn't gained a ton of traction in the US), and some of that cost might be transferred to you, the patient.
So, what's the final verdict?
Well, at the end of the day, it's really up to you. Both techniques, traditional and ultrasonic, will take you to the same destination using different routes. According to Dr. Kim Patrick Murray, ultrasonic rhinoplasty is more precise and requires less recovery time, while other surgeons, like Dr. Lin, prefer the tried-and-tested traditional method. My advice? Do as much research as possible and chat with your plastic surgeon to figure out what's best for you.
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