Integrated Management of the Thick-Skinned Rhinoplasty Patient

Abstract

Patients with thick skin are a challenge in facial plastic surgery. Rhinoplasty is still the most frequently performed facial plastic procedure worldwide and it becomes very difficult to obtain optimal consistent results in these patients. A systematic presurgical skin evaluation is performed dividing skin into type I-III depending on the elasticity, oiliness, presence of skin alterations, size of skin pores, and laxity. Depending on the skin type, presurgical, surgical, and postsurgical management of the epidermis and dermis is defined. Preconditioning and treating thick skin can improve postsurgical results and reduce postsurgical unwanted results.

Superiorly Pediculated Superficial Musculoaponeurotic System Ligament Flap to Control the Supratip

“…All thick-skinned patients are classified into 3 categories (type I, II, III), taking into account thickness, oiliness, elasticity, and alterations in pigmentation of the skin. 6 In type I and type II patients, the pediculated SMAS ligament flap is used routinely. In type III patients, who are those with extremely thick skin and poor elasticity, this flap can be modified.…”

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

“…The surgeon may apply certain surgical maneuvers such as thinning out or thickening of the SSTE to enhance the cosmetic outcome. However, these sometimes tend to be solitarily insufficient 1,3,6,8,9 . Furthermore, pre‐existing skin conditions like acne, rosacea, or eczematous disorders may exacerbate perioperatively.…”

“…Surgeons usually classify the nasal skin into three main classes by inspection and palpation: thick, moderate, and thin skin. This classification is crucial for surgical planning 1–3,6 . So far, several objective methods such as computed tomography, magnetic resonance imaging, and ultrasound have been described to assess the thickness of the nasal SSTE.…”

“…Other features of the integument like seborrhea, porosity, pigmentation disorders, elasticity, sensitivity as well as the presence of dermal pathologies like rosacea, postinflammatory hyperpigmentation (PIH), or acne should be assessed preoperatively, since these conditions may worsen after surgery 1,3,9 …”

“…On the other hand, thick skin may be managed in a synergistic surgical‐medical manner. This applies especially for patients with thickened dermis due to sebaceous gland hyperplasia, who will profit from preoperatively diminishing of the sebaceous gland's activity and hence its hyperplasia, resulting in thinner skin and consequently a better‐defined appearance of the nose 1–3,5 …”