Powered instrumentation for nasal bone reduction: advantages and indications.

OBJECTIVE To evaluate power-assisted bone removal in cosmetic rhinoplasty. DESIGN Nonrandomized, nonblinded, retrospective evaluation of consecutive case series. SETTING Academic facial plastic surgery practice. INTERVENTIONS Power-assisted bone removal in 105 consecutive rhinoplasties requiring nasal bone reduction. MAIN OUTCOME MEASURES Subjective evaluation by patient and surgeon. RESULTS Of the 105 patients undergoing power-assisted bone removal, 102 obtained satisfactory refinement of the nasal dorsum after 1 operation. Three patients required surgical revision of the nasal dorsum following power-assisted bony hump reduction. Of these, 2 required surgical revision for delayed bone regrowth, while the remaining patient required surgical treatment of a persistent bony hump. Ultimately, all 105 patients achieved satisfactory surgical results. No other surgical complications were observed. CONCLUSIONS Power-assisted bone removal is a useful adjunct for bone removal in cosmetic rhinoplasty. This study confirms the previously reported advantages of powered instrumentation for patients with small bony humps or modest bony asymmetries. Moreover, because powered instrumentation is comparatively atraumatic, it may be preferable for use in nasal bones previously weakened by trauma, aging, or prior nasal surgery. Finally, because the powered nasal rasp permits rounding of the bone edges, the characteristic widening associated with flat hump reduction is reduced, and the need for aggressive sidewall infracture is diminished. Complications associated with power-assisted bone removal were rare.