Laser-Assisted Rhinoplasty_ The Future Generation Rhinoplasty Technique to Preserve Anatomy_ A Series of Patients Compared to Patients Undergoing Standard Open Rhinoplasty

1. Background
The authors developed a new small laser hand probe
to perform what we called laser-assisted rhinoplasty.
Performing bone and cartilage reshaping appears to be erbium:yttrium-aluminum-
garnet laser.
This concept was introduced in 1993, and several studies have demonstrated the
feasibility of laser-assisted cartilage reshaping
in porcine and rabbit auricles, and in canine trachea.
9–20
Inspired by these concepts, authors performed laser remodeling in cadaver noses
and then authors developed a new small laser probe to get into the nose and
perform what we called laser-assisted rhinoplasty.

2. STUDY DESIGN
Authors randomized 50 patients into two cohorts:
All patients were operated on by the same senior author (D.B.) between January
of 2017 and January of 2018.

3. Laser-Assisted Rhinoplasty Surgical Technique
1. standard transcolumellar open approach
2. erbium:yttriumaluminum-garnet laser
Laser beam repetition rate and fluences were
decreased during cartilage reshaping. Laser safety
parameters were determined during a previous unpublished cadaveric study.
3. A standard 2-cm tip, 2-mm distance &
Surface perpendicularly

4. Laser-Assisted Rhinoplasty Surgical Technique
4. new 5-cm spatula-like tip - osteotomies
5. OR safety
6. The laser beam was used to perform both the resection of the crura
and the resection of the nasal hump and osteotomies.
7. For each patient, a series of 20 photographs were taken in
standardized poses and a short 4K video was recorded preoperatively
and at 1, 6, 12, 24m.

5. Results

6. Results
- Observed 50 percent less bleeding with the laser-assisted rhinoplasty
technique.
- Clinically noted an edema reduction in the immediate
postoperative period in the laser-assisted rhinoplasty
population and a more rapid recovery.
- No nasal infections or necrosis were recorded in
any patient.
- Pain level was similar in both groups.
- Operative time was slightly longer in the laserassisted
rhinoplasty technique

7. Discussion
1. Basically, rhinoplasty technique remains unchanged; what changes is the
instrument with which osteotomies and cartilage resections are performed.
2. In addition, the constant water flow keeps the field clean and prevents tissue
overheating. The tip of the instrument is floating, and so no force is applied to
the cut, unlike classical osteotomies and even piezoelectric surgery.
3. Osteotomies are extremely precise, and any risk of uncontrolled fracture is
prevented because advancement is fluid and without jerks or resistances in
nasal bone.
4. By modulating the intensity of the laser light, it is possible to perform a real
rhinosculpture by just progressively removing thin layers of bone.

8. Discussion
5. In an independent clinical analysis, patients undergoing classic rhinoplasty presented
a residual defect rate of 12 percent. In most cases, this is a step-shaped deformity. This
type of defect has not been observed in the laser-assisted rhinoplasty population.
6. Clinically, laser assisted rhinoplasty patients developed much less edema in the first
postoperative days; also, complete resolution of the swelling was faster.
7. Study shows that laser surgery is longer than traditional rhinoplasty. The chronometric
difference, in any case, is not particularly significant.

9. • The laser-assisted rhinoplasty technique is feasible, safe, and has no
major complication.
• Aesthetic and functional results can be superimposed onto classic
rhinoplasty but with a higher degree of intraoperative precision and
patient satisfaction, a cleaner field, and less bleeding.
Conclusion

10. THANK YOU FOR YOUR ATTENTIONs
ANY QUESTIONS?