I asked Dr. Keller about piezosurgery. He actually said he's tried it, doesn't like it. He said it takes longer to use, is not as precise and in the right hands a good sharp tool is much better than the piezosurgery. He said a few of the max facs at mayo have used it but they usually go back to the using sharp tools. Said it doesn't really make much of a difference with regards to nerve damage either. Don't know if he's just set in his ways and old school, or if he's right.