Dermatological assessment of thick‐skinned patients before rhinoplasty—what may surgeons ask for?

Abstract

Rhinoplasty is considered a very challenging surgery since minimal changes of this central area of the face may significantly impact a person's appearance and self‐awareness. This is even more challenging in thick‐skinned patients because results are less predictable, and changes to the osseocartilaginous framework (OCF) may not be sufficiently visible due to the blanket effect of the thick skin. Furthermore, pre‐existing skin conditions may exacerbate following surgery. Therefore, managing patients with extremely thick skin or patients who suffer from pre‐existing dermatological conditions such as rosacea or acne requires a synergy of surgeons and dermatologists to achieve optimal results. In this article, we review the most significant pre‐ and post‐surgical regimens that surgeons and dermatologists should apply in selected patients to achieve optimal results after rhinoplasty.

Comparison Between Patient and Plastic Surgeon Aesthetic Analysis in Rhinoplasty Consultation

“…15 Saadoun et al explored the importance of establishing any preexisting skin condition (thick skin, rocesea, acne) that the patient might present with and treat accordingly in a multidisciplinary manner, including a dermatologist to ensure a good cosmetic outcome. 16 This form of assessment, which does not take into account the patients' view regarding their condition, is one sided, whereas the assessment presented by our article, which is two sided, might present with better and more acceptable outcomes from the patients' point of view.…”

Analysis of the use of isotretinoin as an adjuvant in rhinoplasty

“…1 It is a complex surgery that can be even more challenging in patients with thick, oily skin that are prone to acne or rosacea. 3,4 Patients of certain ethnic groups, such as Afro-descendant, Mestizo, and Asian patients, tend to have a weaker nasal bone and cartilaginous structure that is usually covered by thicker skin. 5 In addition, acne may increase by up to 27% in the first month after rhinoplasty, thereby generating more local inflammation.…”

“…A perioperative treatment regimen is important for better conditioning of this type of skin. 3,5 Isotretinoin is a first-generation retinoid that has the characteristic of being sebostatic and, therefore, extremely effective in the treatment of acne. 6 Since 1980, it was believed that isotretinoin should be suspended from 6 to 24 months before a surgical procedure due to the risk of delayed or inadequate healing (such as keloid and hypertrophic scars), but some studies show its potential to reduce the thickness of the face skin, thus leading to a better result of rhinoplasty, without having a negative effect on healing.…”

The Role of Autologous Fat Grafting in Rhinoplasty

“…This unique metabolic characteristic emphasizes the importance of an intact, well-vascularized nasal SSTE to assure adequate perfusion for the nasal cartilaginous framework. [28][29][30][31] Revision after primary surgery is complicated by the nasal SSTE being either directly involved with or in close proximity to dense fibrous scar notable for low compliance and poor vascularity. 32 This scarring may manifest as a "skeletonized" appearance of the nose in thin-skinned noses and facilitate structural deformities that occur due to the imbalance between the scar contracture of the nasal SSTE and the weak cartilage underneath (e.g., alar pinching, alar retraction, cloverleaf deformity).…”

“…The nasal cartilaginous framework meets its metabolic needs mainly through diffusion from the covering SSTE and the nasal lining mucosa. This unique metabolic characteristic emphasizes the importance of an intact, well-vascularized nasal SSTE to assure adequate perfusion for the nasal cartilaginous framework [28][29][30][31] .…”