How and Why Dr. Gerbault Invented Ultrasonic Rhinoplasty?

Rhinoplasty has long been considered one of the most technically demanding procedures in aesthetic and reconstructive facial surgery. For decades, surgeons relied on traditional tools such as rasps, chisels, and osteotomes to reshape the nasal bones. These instruments, while effective, offered limited precision and often caused significant postoperative bruising, swelling, and discomfort.

In the early 2010s, a profound shift began when French facial plastic surgeon Dr. Olivier Gerbault developed what would become known as ultrasonic rhinoplasty, or Piezo rhinoplasty. His contribution dramatically changed how surgeons approach nasal bone reshaping and opened a new era in rhinoplasty techniques.

Understanding how and why this innovation emerged requires exploring both the limitations of traditional methods and the motivations behind the search for a more controlled, tissue-sparing approach.

The Context: Why Rhinoplasty Needed Innovation

Rhinoplasty is a complex and delicate procedure because the nose is both a functional organ and a central aesthetic unit of the face. Even small changes in bone or cartilage can have significant consequences for breathing and appearance. Surgeons had long recognized two major challenges in traditional bone work:

1. Lack of Ultra-Fine Precision

Manual tools allow surgeons to break or file bone, but the control is largely dependent on hand movement. Subtle refinements—such as smoothing irregularities or reshaping asymmetric bones—were difficult to perform with millimetric precision. Even experienced surgeons sometimes encountered minor asymmetries or needed to make adjustments during healing.

2. Soft Tissue Trauma

Chisels and rasps interact not only with bone but also with adjacent tissues:

• periosteum,
• tiny blood vessels,
• subcutaneous tissue,
• and delicate skin layers.

This contact generates trauma that leads to swelling, bruising around the eyes, and a longer recovery period. Although these effects are temporary, they remained an inherent limitation of traditional rhinoplasty techniques.

3. Variability in Outcomes

The manual nature of the tools made certain steps less predictable. Small, unintended bone cracks (microfractures) could occur during osteotomies. These microfractures might not always affect the final result, but they increased the risk of irregularities or asymmetries.

Given these challenges, many surgeons sought ways to make rhinoplasty more precise and controlled. Dr. Gerbault was one of the figures who explored new technological solutions to improve both surgical outcomes and patient experience.

Why Dr. Gerbault Began Searching for a New Method

Dr. Olivier Gerbault had long been involved in research on structural and preservation rhinoplasty. His focus was not only on achieving aesthetically pleasing results but also on ensuring long-term stability and functional integrity. Over his years of practice, he observed several recurring issues with traditional methods:

• Patients often experienced significant bruising despite careful technique.
• Fine and delicate bone adjustments were not always achievable with manual tools.
• Revision surgeries could be particularly challenging when dealing with fragile, previously operated bones.

These limitations encouraged him to look for tools that could deliver more predictable and more controlled bone reshaping.

Around the same time, ultrasonic devices were already being used in other medical disciplines, such as orthopedic and dental surgery, where precision and bone selectivity were crucial. This sparked the idea that a similar technology might be adapted for nasal surgery.

The Development of Ultrasonic Rhinoplasty

Dr. Gerbault began experimenting with ultrasonic devices—tools that use high-frequency vibrations to cut bone while sparing surrounding soft tissue. These devices were originally too large or not specifically adapted to the small, intricate structures of the nose. To make them suitable for rhinoplasty, new tips and shapes needed to be designed.

Over several years, he collaborated with engineers to develop specialized instruments capable of:

• targeting only bone,
• performing controlled osteotomies,
• allowing fine sculpting rather than bone breaking,
• fitting precisely within the narrow nasal anatomy.

This collaboration ultimately produced a set of tools powered by ultrasonic energy, designed specifically for rhinoplasty.

In 2013, Dr. Gerbault presented the first standardized approach to what he called ultrasonic rhinoplasty. The method quickly gained interest among surgeons seeking a more refined and predictable technique.

How Ultrasonic Rhinoplasty Works

Ultrasonic rhinoplasty uses instruments that emit micro-vibrations at frequencies that selectively affect bone. Soft tissues—such as cartilage, muscles, nerves, and blood vessels—remain largely unaffected because the device is tuned to act only on mineralized structures.

This selectivity offers several practical advantages:

1. Controlled Bone Reshaping

Instead of breaking bones with force, surgeons can sculpt them. This includes:

• smoothing irregularities,
• reshaping asymmetric bones,
• refining the nasal dorsum with millimetric precision.

2. Reduced Soft Tissue Injury

Because the tool does not damage surrounding tissues, postoperative swelling and bruising are often reduced, and recovery is typically more comfortable.

3. More Predictable Results

The precision of the device allows surgeons to achieve symmetrical and stable reshaping, leading to more consistent outcomes.

Why the Innovation Matters

Ultrasonic rhinoplasty represents a shift from “bone breaking” to bone sculpting. This conceptual change has influenced surgical training and continues to shape how rhinoplasty is approached worldwide.

The innovation also aligns with broader trends in aesthetic surgery:

• Minimally invasive procedures
• Tissue preservation
• Faster recovery times

Greater emphasis on natural, harmonious results

Although ultrasonic rhinoplasty is not the only viable method and traditional rhinoplasty can still achieve excellent outcomes, the introduction of ultrasonic tools has provided surgeons with an alternative that addresses many of the technical constraints of older instruments.

A Continuing Evolution in Rhinoplasty Techniques

The development of ultrasonic rhinoplasty marked an important milestone in the field, but the technique continues to evolve. New device tips, refined surgical protocols, and ongoing clinical experience are helping expand its applications. Some surgeons combine ultrasonic tools with structural or preservation techniques, while others adopt hybrid approaches depending on the patient’s anatomy and goals.

Ultimately, the invention of ultrasonic rhinoplasty reflects the broader evolution of modern nasal surgery—toward greater precision, safer methods, and improved patient comfort. Dr. Gerbault’s contribution played a significant role in this transformation, but the technique today belongs to a wider international community of surgeons who continue to refine and expand its potential.