Piezo and Rhinoplasty: “Basic Knowledge for Plastic Surgery in 10 lines”
It is a technique which brought by Tomaso Vercellotti to the surgery in 1980s, in order to rasp bone tissue with micro hammer by creating ultrasonic sound waves from electric current in the craniotomy (skull base surgery), genioplasty and rhinoplasty and in order to give shape by cutting.
Nowadays, many ear-nose and throat specialists who have not education on Plastic Reconstructive and Plastic Surgery are interested in this technique.
Why does this device get attention now?
Piezo Surgery, full name ultrasonic bone shaping device, is used in order to perform bone shaping easily and safely and to extend operation period. As a reinforced motor system, this technique is used in the different areas for decades, for example: neurosurgery, flap surgery, plastic surgery, maxillofacial surgery, craniofacial surgery and dentistry.
The procedure has been considered as a rescuer in terms of life saver technique in order to complete basic knowledge and training deficiencies in plastic surgery such as bone shaping and corrective procedures for other plastic surgeons who face complications related to nasal bone because of not having basic education related to the surgery.
The system which provides quick recovery period by causing less bruise or swelling postoperative period, is introduced in the name of Piezo Surgery and the new technique for the Rhinoplasty on social media. Thus, many people who saw/read the advertisements of this device in the social media (wrong and incomplete information) started to look for doctor for Piezo procedure instead of rhinoplasty. Briefly, the competence, expertise, qualification people look for is Piezo, not experience.
This motor bone cutting and shaping technique which is understood that it has been produced in order to gain economic advantage and was the subject of advertising, reminds that the plastic surgery notion and knowledge is absolutely necessary to perform plastic surgeries in terms of patient health and safety.
10 basic (plastic) surgical notion for Piezo device and Rhinoplasty for the surgeons who are not plastic surgeon are eager to aesthetic procedures:
- As a universal principle, all surgical procedures are required basic and sufficient plastic surgical experience, competence and minimum tectology. In the plastic surgery procedures, instead of looking for the information and surgical competence, putting forward a device by overdrawing as a new technique, introducing it as a future device, and asserting that the device and technique are only used by the chosen people, in other words, asserting that the people who use the device perform Rhinoplasty more successfully, are considered as a misdirection for patients by the plastic surgeons. This commercial effort has no meaning in the intellectual and serious academic circles. With carefully work and respect for tissues principles, and safe appropriate techniques, similar successful results are obtained after each surgery.
- It is wrong and incomplete surgical notion to regard the device as responsible for swelling and bruise and to assert that the patient has less bruise and swelling in the face thanks to this device. There are many reasons that may cause bruise and swelling in the surgery. Only one of them is the atraumatic approach to bone. The presence of anemia, vitamin deficiencies, blood thinners use before surgery, hormone or corticosteroid drug use, congenital wound healing problems, coagulopathy, anesthesia type and period, the level of difficulty of surgery, the surgery numbers that the patient underwent, age, the general health level, the supplementary blood thinners drug use etc. This is fundamental/basic surgical notion. A real plastic surgeon never skips these variables, its importance and ordering. Postoperative bruising, swelling and late recovery are the results of this examination.
- Successful results in rhinoplasty are not related to whether a device is used in tissue, and by using all appropriate surgical instruments carefully. This is not only plastic surgery information but also basic surgical information.
- A successful rhinoplasty is not performed by using a device in a tissue, is performed by using most appropriate techniques and preferences in all aesthetical units such as incision, depth, cartilage, concha, muscle, blood vessels, nerves, ligaments, adipose tissue, suspensory ligament, and by using graft/flap, and materials.
- Successful result in rhinoplasty is obtained by respecting for tissue as well as surgical engineering and by competence/qualification for procedure which is planned for the patient and personal treatment, which is gained/learnt plastic surgery education. If we compare this competence to the expected effect of the use of device and technique used only in bone surgery, we can see this device preference and importance as a specialty importance.
- In some cases, successful rhinoplasty is performed by the ability to manage/deal with an urgent medical condition which may be occurred due to unforeseen and uncontrolled conditions (cases depending on patient and anesthesia) during the surgery. This competence and ability to manage the surgical process is not limited to a single device (instrument)
- Each device used in rhinoplasty has usage and learning-curve. The ability to use the device effectively can only be evaluated over time and according to the results obtained by many patients. Therefore, the use of a device cannot guarantee the expected and alleged results.
- The possible side effects of every device used in surgery and the complications that may be caused by inexperienced doctors, have been purchased by buying that device. Having a hammer in your hand does not prevent from hitting the finger accidentally. The condition that prevents this fault is related to the attention and experience of the surgeon, not in the power of the hammer. Just as with good results, only the surgeon is responsible for disappointing results. For this reason, compensation cases are filed against doctors or hospitals, not to devices or companies. Not providing information or misinformation about possible side effects of the device is a negligence ethically, and is a crime in accordance with European Standards. Surgeon, not the device, is responsible for this case. Therefore, it is not proper approach that “I only use the devices that I designed. No one uses the device that I have. Therefore, my patients have quick recovery period and do not have bruise” This approach is not for physician or surgeon. Also, it is undeniable that all materials/devices have a seller, and every seller has a buyer in our country.
- Introducing a device with the trade name is a simple careless approach of medicine. The appropriate name is the generic or scientific name of the device or product. This is also for Pizza brand and for Piezo.
- Having a device does not make you best surgeon, or visionary, or good surgeon or good physician. The only area of expertise to perform plastic surgery is Plastic Reconstructive and Plastic Surgery in Turkey. For these reasons, rhinoplasty and other plastic surgeries performed by other surgeons who seek economic advantages should not be valid according to laws. In case of not achieving this, it is inevitable to pay price for the patients due to lack of information about 10 basic information abovementioned.
People/colleagues who introduce themselves as a plastic surgeon by taking advantage of the legal gap and try to perform surgery for only gaining economic profits, don’t forget that “everyone is responsible for their own garden”, “You do the crime you do the time”
I pay tribute to the all honorable colleagues and professors who work within legal and ethical conditions, do not attempt frontier infringements and work by not making concessions about ethical and professional ethics principles, and I greet respectfully these colleagues/professors who believe in science, law, conscience and specialized knowledge. I will continue to be follower and student of them.
Note: This text has been reviewed and revised in accordance with the criticisms and suggestions.
