Use of 5-Fluorouracil for Management of the Thick-Skinned Nose

Abstract

Patients with a thick nasal skin and soft tissue envelope can have unpredictable results and irregular scarring after rhinoplasty surgery. These patients typically have sebaceous tissue over the nasal tip and are particularly susceptible to soft tissue polly beak formation and excess scar tissue in the radix, tip, and septum. Targeted injections of 5-fluorouracil alone or mixed with low concentrations of steroid can be useful to prevent and treat excess postoperative scar tissue deposition. Ideally, four to six injections are performed every 1 to 4 weeks beginning 1 week postoperatively. The injections are most beneficial when performed within the first 3 months after surgery. Even a single injection may improve outcomes with minimal side effects.

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

“…Generally, thick‐skinned patients are more prone to prolonged edema as well as scar formation after a rhinoplasty. This is especially true in the nasal tip area, which can result in an ill‐defined amorphous nose 1,3,6,28 …”

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

“…2,32,39 Thick-skinned patients are prone to prolonged edema and scar formation especially in the supratip area. 2,6,23,77 Promisingly, oral isotretinoin has been recently used after surgery in thick-skinned patients to achieve more definition of the nasal tip and diminish scar formation (►Fig. 5).…”

“…5-FU is absolutely contraindicated in pregnancy or breastfeeding. 77 If blanching appears in the overlying skin during injecting triamcinolone or 5-FU, then the injection is in the dermis and the needle should be advanced deeper into the subcutaneous tissue. 77,78 It is not uncommon for thick-skinned patients to have increased porosity and rough skin texture after a rhinoplasty.…”

“…77 If blanching appears in the overlying skin during injecting triamcinolone or 5-FU, then the injection is in the dermis and the needle should be advanced deeper into the subcutaneous tissue. 77,78 It is not uncommon for thick-skinned patients to have increased porosity and rough skin texture after a rhinoplasty. Therefore, a chemical peel with trichloroacetic acid in combination fractionated CO 2 laser may be helpful.…”

The Need for Innovation in Rhinoplasty

“…Controlling healing is often key to maintaining the changes achieved in the operative suite. Today's surgeons are experimenting with medicines such as 5-fluorouracil 28 and isotretinoin 29 postoperatively to reduce scarring and shrink the soft tissue envelope. Furthermore, simply understanding the "normal" healing process is only recently being academically delineated.…”