Isotretinoin Use in Thick-Skinned Rhinoplasty Patients

Abstract

One of the characteristics of mestizo patients can be the thick sebaceous skin associated with a poor osteocartilaginous underlying nasal structure. In spite of using a proper structural approach where grafts and sutures are used to define the nasal tip, frequently the results are suboptimal. Surgical techniques have been described to reduce the thickness of the skin-soft tissue envelope, but these frequently give unreliable results. The monitored use of isotretinoin given orally as a complement after performing a rhinoplasty can adequately control the production of the sebaceous glands and thin the skin-subcutaneous tissue envelope in a uniform fashion without compromising the underlying bony and cartilaginous structures of the nose. Patients ideally should be treated jointly with a dermatologist and be followed closely to monitor hepatic function. Follow-up after 2 years with pre- and postoperative pictures shows improved definition of the nasal tip and dramatic improvement on sebaceous gland production.

Systemic retinoids and scar dehiscence

“…[6] All three of these patients underwent septorhinoplasty before starting oral isotretinoin treatment in the previous 2 years and all developed nasal tip deformities within 6 months of the initiation of isotretinoin treatment. Authors concluded that nasal tip deformity had developed due to isotretinoin's creation of imbalance between collagen production and degradation, as well as the accentuated “shrink and wrap” phenomenon associated with the abnormally thin nasal epidermis, and recommended postponing isotretinoin treatment for a minimum of 2 years following rhinoplasty;[6] however, Cobo and Vitery[7] reported that concomitant initiation of isotretinoin treatment with rhinoplasty helped to define the nasal tip and improved the surgical outcome in thick-skinned patients.…”

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

“…Furthermore, pre‐existing skin conditions like acne, rosacea, or eczematous disorders may exacerbate perioperatively. Consequently, in selected cases with difficult SSTE, the collaboration with a dermatologist may help optimize the SSTE preoperatively and avoid postoperative sequelae 1–5,9 …”

“…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.…”

“…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 …”

“…In patients with pre‐existing skin conditions like inherent thick sebaceous skin, acne, or rosacea, managing the SSTE needs the perioperative collaboration between the surgeon and the dermatologist to ensure optimal postoperative outcomes 1–5 …”