Diamond Rhinoplasty: Ultrasonic Rhinoplasty with Piezo

The new technique uses ultrasound, permitting the surgeon to utilize rhinosculpture while avoiding osteotomies (breaking bones)

What is Piezo Rhinoplasty?

Piezo is the surgery system that uses electric power and produces ultrasonic vibration in a metallic tip allowing the surgeon to “sculpt” the nasal bones themselves. The surgeon can alter the shape and the thickness of the bones without damaging the surrounding soft tissues and sometimes even cut the nasal bones if necessary
Piezo Ultrasonic Diamond Rhinoplasty system dr mireas Rhinoplasty Expert
Piezotome Dual+
Piezo Ultrasonic Diamond Rhinoplasty system microtips dr mireas
Piezo rhinoplasty microtips
  • Piezo uses ultrasound vibrations with a frequency of 25-29 kHz to change the shape of the bones and leave totally intact the surrounding soft tissues that can be affected by ultrasound vibration of over 50kHz (skin, mucosa, vessels and nerves)
  • Piezo technology has been very well known for several years and is used by dentists and maxillofacial surgeons with exceptional results in dealing with maxilla and premaxilla bones
  • During a rhinoplasty the surgeon usually use very narrow paths and this fact along with the large size of the conventional piezo tips led to a significant delay in using the piezo system in rhinoplasties
Diamond Piezo Ultrasonic Rhinoplasty without osteotomies dr mireas athens

The revolutionary technique, Dr. Mireas' expertise and Greece’s global representation.

In 2013 everything changed with the construction of a series of special microtips dedicated to rhinoplasty, and a totally new rhinoplasty surgery technique that was developed by the globally renowned pioneers of the new system Olivier Gerbault (France) and Milos Kovacevi c (Germany).

Piezo Ultrasonic Diamond Rhinoplasty Dr.Mireas and Dr.Gerbault in Paris France                                               Description: Piezo Ultrasonic Diamond Rhinoplasty Dr.Mireas and Dr.Kovacevic in Hamburg Germany
Dr.Mireas with Dr.Gerbault in Paris France
Piezo Ultrasonic Diamond Rhinoplasty Dr.Mireas and Dr.Kovacevic in Hamburg Germany
Dr.Mireas with Dr.Kovacevic in Hamburg Germany

Dr. Mireas was trained by these two pioneers of the system in Paris and Hamburg and finally became the Greek Expert in Ultrasonic Surgery in 2017

  • Today, piezo is globally accepted as the most sophisticated surgery system for rhinoplasties, whether primary or revision.
  • It allows the surgeon to achieve much better results as well as performing the surgery with greater accuracy and under the absolute control of the surgical area

These are the main reasons why since 2017 Dr.Mireas has exclusively utilized piezo in all the rhinoplasties he performs.

As a rhinoplasty expert and opinion leader for the Piezo rhinoplasty system, Dr. Mireas is an invited speaker and round table’s moderator at the most prestigious Congresses and Rhinoplasty Meeting globally representing Greece’s ENT community
Diamond Piezo Ultrasonic Rhinoplasty. Dr Mireas at
International Meeting American Academy of Facial Plastic Surgery 2019.
Advances in Rhinoplasty Orlando 2019 American Academy of Facial Plastic Surgery
: “Ultrasonic Rhinoplasty”. Dr Mireas at International Meeting American Academy of Facial Plastic Surgery 2019. Diamond Piezo Ultrasonic Rhinoplasty.
Advances in Rhinoplasty Orlando 2019 With O. Gerbault
“Ultrasonic Rhinoplasty”. Dr Mireas an Expert at Diamond Piezo Ultrasonic Rhinoplasty. 2019 : International Meeting American Academy of Facial Plastic Surgery.
Advances in Rhinoplasty Orlando 2019 With O. Gerbault, A. Goksel, E. Pribitkin, J-R Jones, E. Ilhan
Diamond Piezo Ultrasonic Rhinoplasty.   Dr Mireas Rhinoplasty Expert at Regensburg Annual Congress of European Academy of Facial Plastic Surgery 2018.
Annual Congress of EAFPS Regensburg 2018 European Academy of Facial Plastic Surgery
Diamond Piezo Ultrasonic Rhinoplasty.   Dr Mireas at Regensburg Annual Congress of European Academy of Facial Plastic Surgery 2018
Annual Congress of EAFPS Regensburg 2018 "Piezo vs Standard Techniques"
Diamond Piezo Ultrasonic Rhinoplasty Dr Mireas at Regensburg Annual Congress of European Academy of Facial Plastic Surgery 2018 round table
Annual Congress of EAFPS Regensburg 2018 With D.Toriumi, D. Becker, H.Gassner, S.Pearlman

Old Techniques and their Drawbacks

The main fear of patients was always the “bone breaking” during a rhinoplasty surgery and

 a constant desire was to avoid that


The Past
Conventional surgical instruments have been much the same for over a century now with only some slight improvements and modifications.
The key tools used in bony vault surgery are saws, rasps and osteotomes.


Traditionally, the main goals of the surgeon during a rhinoplasty were

·       To lower a hump

·       To narrow a wide nose and straighten a deviated one by breaking the nasal bones

Often, the outcome of a surgery performed by these conventional tools was satisfactory but a significant percentage of nasal bones do not breake at the exact spot the surgeon would prefer or the osteotomy line is not the perfect one.
This created slight or serious deformities or even nasal breathing problems
Moreover, the bony part of the surgery was always the totally blind part of the operation even when an open approach was followed
It must also be highlighted that the only way to narrow a wide nose was to break and relocate the nasal wall while there was no possibility to
reduce the actual thickness of the bone itself

The Advantages of Piezo and why Ultrasonic rhinoplasty is considered to be the operation of the Future

Ultrasonic rhinoplasty is totally different to the conventional procedure and in general with Piezo:

· We can actually sculpt the nasal bones

· We can lower the hump of the nose by removing only the covering bony cap of the dorsum

· We can modify the nasal bones even in cases of severe asymmetries.

· We can reduce the thickness of the nasal bones themselves

· We can narrow a wide nose in this way and in many cases, osteotomies are not necessary because the narrowing is perfect

· If we need even more narrowing, we cut the bones under direct vision in order to relocate them medially and achieve the narrowing we want.

· Everything is performed under direct vision and total control

· We completely preserve all the surrounding soft tissues like skin, mucosa, vessels and nerves.

· Ecchymosis and bruising are less compared to standard procedures.

· Post-operative period after piezo rhinoplasty is lighter and completely painles

Ultrasonic Piezo Rhinoplasty, Before – After surgery photo. Dr Mireas Ultrasonic Rhinoplasty Athens Greece

Revision Rhinoplasties today

Particularly in revision surgeries with many complications, the decision for a revision was until recently, extremely difficult to take.

Today with the ultrasonic system everything is easier because:

  • We can deal with excellent precision even bones that are fused totally wrong after a bad initial surgery
  • We can easily modify even totally mobile bones
  • We can operate immediately after a recent severe injury without waiting for months  even in cases with multiple and asymmetrical fractures

Why Piezo surgery is so revolutionary for surgeons?

Piezo offer a surgeon so many different and easy solutions to severe problems he/she might have to deal with.

diamond ultrasonic piezo rhinoplasty without osteotomies dr mireas athens  . Intraoperative photo. Dr Mireas

So, with Piezo the surgeon:

  • Can actually see the bone he wants to modify
  • Can sculpt even mobile bones easily, thus obliterating asymmetries that would be impossible to deal with by using conventional tools
  • Has an excellent control of the hump he wants to remove
  • Can remove any kind of bony spur with precision
  • Can reduce the actual thickness of the nasal bones, particularly in patients with pronounced features.
  • Can easily deal with mobile bones immediately after a severe injury, as well as in cases where he wants to correct an osteotomy line or even at the end of the surgery where the bony vault is mobile
  • Easily preserves the skin, the mucosa, the vessels and all the surrounding soft tissues because piezo affects only hard tissues like bones and firm cartilages like rib cartilages
  • Can perform lateral osteotomies at the exact line he wants because he operates under direct vision and not blindly by using only palpation
  • Especially in revision surgeries, he can operate with great precision and safety without the risk of an osteotomy that follows the “wrong path” of the old osteotomy

Piezo Surgery in simple Steps

Ultrasonic piezo surgery in a few words:

Your visit to our Rhinoplasty Center, the Consultation and the 3D Simulation with the Vectra 3D Imaging System of Canfield Scientific, NJ – USA

After taking your personal history, Dr.Mireas performs and records an endoscopy of your nose in order to explain to you on the screen everything concerning the architecture of your nose, like septum deviations, spurs, inferior turbinates’ hypertrophy as well as any other anatomical issues.

Then, with the use of the Vectra 3D Imaging System of Canfield Scientific, NJ – USA which is the most advanced and sophisticated system worldwide for rhinoplasty surgeries, a 3D image of your face is taken and analyzed. Together with Dr. Mireas you can discuss about everything you might want to change to your nose and actually see it in the 3D simulator and finally decide what’s the best choice for your face, eliminating all your worries and hesitations prior to surgery

Diamond Piezo Surgery

The day of the surgery you have to be at the hospital just 2 hours prior to the scheduled operation

Our Specialized Anesthesiologist will examine you after reviewing your full preoperative examination results, which include blood tests, chest X-rays and HCG

The duration of the surgery varies from 1.5 to 4 hours depending on the case

We usually use an internal ointment instead of any kind of internal packing to avoid the discomfort of removal

We place a small external plastic splint which is removed 6-7 days after surgery

Just 6 hours after the surgery you can leave the hospital. You can also leave the next day if you find it more convenient to you

You will have to take antibiotics for just 3 days post op and take care of your internal nose cleaning by using nasal wash and an ointment for lubrication

No painkillers are prescribed because the post-op period is totally painless with our Diamond Piezo Rhinoplasty

External splint removal – 6 Days after surgery

Four to six days after surgery we remove the external thermoplastic splint that was placed during the operation. This removal is totally painless and lasts only one minute.

We usually perform a slight cleaning of the nose and we remove three tiny stiches. The whole procedure lasts no more than 5 minutes and is completely painless.

Post-operative period

After splint removal the patient can safely return home at once. For international patients we must highlight that they are fit to fly without any kind of restriction regarding their destination. Even patients who have to travel overseas can return back home safely.

Post-op care is simple and includes internal nasal cleaning with natural saline (or similar products) followed by lubricating nasal ointment placement, three times per day for a month

For more detailed post-op instructions click here

Medically speaking there is no reason for any more visits to our Center because Diamond Piezo Rhinoplasty has a guaranteed and controllable result

Even so, within the strong relationship we develop with our patients, we recommend a second visit 1 year after surgery as well as another one in the 3rd or 5th year postop. Patients from abroad honor us by sending several photos by email from their home countries

My Rhinoplasty from A to Z

See a step by step procedure towards your rhinoplasty surgery. Starting from your first visit to our Rhinoplasty Center, passing through the Surgery day and reaching the easy post-op period.

Watch several photos, videos and authentic testimonials of various rhinoplasty cases.

FAQ's about Ultrasonic Rhinoplasty with Piezo

Read the answers to the most common questions about the Ultrasonic Rhinoplasty with Piezo

How does Piezo rhinosculpture differ from conventional rhinoplasty?

It is a new technique in which the surgeon uses piezoelectric tools to sculpt the bones of the nose with perfect visibility and absolute precision, and without causing any damage to the surrounding sensitive tissue. It offers better results, minimizing swelling, bruising and pain after surgery.

Is ultrasonic rhinoplasty better than conventional rhinoplasty?

The use of ultrasonic vibrations gives the surgeon complete control over the reshaping of the nasal bone. This is true rhinosculpture, with absolute precision and perfect control, avoiding the ‘approximate’ corrections of the past and so achieving the best possible result.

How long do the results of Piezo ultrasonic rhinoplasty last?

The results of ultrasonic rhinoplasty are permanent and will last a lifetime.

Dr. Mireas uses the most advanced surgical techniques to add strength and stability to the nasal framework, so the improvement to your breathing is permanent and the appearance of your nose does not change over time.

What is the right age for ultrasonic rhinoplasty?

There is no ‘right’ age for rhinoplasty.

In the case of young people, rhinoplasty surgery can safely be performed once the nose is fully developed. This is usually at the age of 16 for girls and 18 for boys.

Elderly people can undergo rhinoplasty for aesthetic or functional reasons regardless of their age.

The Uniqueness of Exelixis Medical Institute

Patients that come to us immediately get a precise idea of what to expect from their own fully customized rhinoplasty surgery.

Dr. George Mireas, head of our surgery team, is a member of the “Emerging Trends and Technologies Committee” of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). He specializes in rhinoplasty surgeries and has been the Opinion Leader of Greece in Diamond Piezo Rhinoplasty since 2017.

Prior to Surgery

  • A meticulous examination of your nose structure.
  • 3D Rhinoplasty simulation with the Vectra 3D Imaging System of Canfield Scientific, NJ – USA. This is the only place in Greece where you can find the sophisticated system and see for yourself the final outcome of your nose job in 3D
  • With the VIP-Rhinoplasty concept in our dedicated Exelixis Medical Center and our specially designed Medical Tourism Procedure we serve patients from all over the world, offering the highest services one could ask for

The Surgery

  • The New Diamond Ultrasonic Piezo Rhinoplasty that allows the surgeon to “sculpt” the nose and replaces osteotomes and saws has been performed in Greece since 2017 by the rhinoplasty expert Dr. George Mireas

After Surgery

  • Totally painless post-op period. No pain killers needed.
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