Piezoelectric Versus Conventional Rhinoplasty: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Piezoelectric osteotomy may reduce postoperative morbidity after rhinoplasty but time-based effects remain uncertain. The aim of this review was to understand the time-based effectiveness and safety of piezoelectric osteotomy vs conventional methods. A search was performed of major databases and trial registries from inception to 1 December 2025 for randomized trials comparing piezoelectric versus conventional rhinoplasty. The study was conducted in accordance with PRISMA guidelines and was registered in PROSPERO (CRD420261277439). Random-effects meta-analyses pooled continuous outcomes as standardized mean differences (SMDs) and binary outcomes as risk ratios (RRs); ROB-2 and Grading of Recommendation, Assessment, Development and Evaluation (GRADE) were applied. Nineteen studies met the inclusion criteria (905 patients; 476 piezo, 475 conventional), of which 15 were pooled. Edema generally favored piezo across postoperative days (PODs) within the first week, reaching statistical significance at POD2 (SMD, -0.92; 95 CI, -1.70 to -0.13) and POD7 (SMD, -0.64; 95 CI, -1.06 to -0.22), but not at POD1, POD3, or POD4. Similarly, ecchymosis was significantly reduced at POD1 (SMD, -1.33; 95 CI, -2.59 to -0.07), POD2 (SMD, -1.13; 95 CI, -1.97 to -0.30), and POD7 (SMD, -0.62; 95 CI, -1.16 to -0.08). Pain at POD2 was also lower with piezo (SMD, -1.23; 95, CI, -1.90 to -0.57). Mucosal integrity loss occurred in none of the piezo cases and was significantly less frequent than in controls (RR, 0.09; 95 CI, 0.02-0.44). Osteotomy duration did not differ significantly between groups and showed considerable heterogeneity. Publication bias and GRADE assessment results were acceptable. Piezoelectric rhinoplasty improves early swelling, bruising, pain, and mucosal safety vs conventional osteotomy, while operative time remains uncertain.Level of Evidence: 2 (Therapeutic)For image description, please refer to the figure legend and surrounding text.