Rhinoplasty in Guadalajara, Mexico

The Art and Precision in Nasal Surgery: Key Approaches and Piezotome Technology

By: Dr. Juan Gordillo, Certified Plastic Surgeon, Guadalajara

I am Dr. Juan Gordillo, a certified plastic surgeon based in Guadalajara, practicing at Hospital Puerta de Hierro Sur, and my goal is to harmonize the face by combining aesthetics and function in every rhinoplasty. To achieve outstanding results, facial surgeons have advanced techniques at our disposal: the open and closed approaches, enhanced by piezoelectric technology. The choice of method is customized based on the patient’s unique anatomy and the complexity of the desired changes.

The open approach is distinguished by a small incision across the columella (the strip of skin between the nostrils). This incision, which becomes nearly imperceptible over time, allows the surgeon to lift the nasal skin, offering direct and complete visualization of the bony and cartilaginous structures. This visibility is essential for complex cases, secondary corrections, or when precise tip manipulation and cartilage graft placement are required.

On the other hand, closed (or endonasal) rhinoplasty is performed with all incisions hidden inside the nostrils, meaning no visible external scars. By not fully elevating the skin, this technique tends to result in less post-operative swelling and a slightly faster recovery. It is ideal for minor modifications or for treating a dorsal hump where the nasal tip does not require extensive revision.

Regardless of the approach, the incorporation of the Piezotome (ultrasonic surgery) has revolutionized bone reshaping. Unlike traditional methods, the Piezotome uses high-frequency ultrasonic waves to cut and polish the bone with millimeter precision. The main advantage is safety and minimal invasiveness: it only affects bone tissue, preserving surrounding soft tissues, blood vessels, and nerves. This translates into less trauma, which significantly reduces bleeding, bruising, and post-operative swelling (edema).

In summary, in my practice in Guadalajara, there is no “better” technique, but rather the most suitable one for each nose. As a surgeon, I combine the best approach technique (open for complexity, closed for simplicity) with the precision of technology like the Piezotome, ensuring optimal aesthetic and functional results.

Medical References

For those who wish to delve deeper into the scientific evidence behind these techniques, here are links to relevant medical studies:

• Comparison of Approaches (Open vs. Closed):
  • Outcomes of Open Versus Closed Rhinoplasty, a Systematic Review and Meta-analysis (Meta-analysis concluding that aesthetic and functional outcomes are comparable, and the choice depends on surgeon preference and case-specific factors.)
  • Comparing both Open and Closed Techniques in Rhinoplasty (A review highlighting the benefits and limitations of each technique, noting open is better for complex changes while closed offers faster recovery.)
• Advantages of Piezoelectric Surgery (Piezotome):
  • Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? (Systematic review emphasizing the significant reduction in edema, ecchymosis, and mucosal complications with Piezotome use.)
  • Role of Piezoelectric Instrumentation in Rhinoplasty Surgery (Study supporting the adoption of Piezotome for more precise analysis and surgical execution, particularly in altering the osseocartilaginous vault.