Isotretinoin in Thick-Skin Rhinoplasty: A Review

Introduction  Thick-skinned patients are prevalent in the general population worldwide and represent a challenge for the rhinoplasty surgeon. The use of oral isotretinoin before and/or after surgery is a possible adjuvant treatment that can facilitate intraoperative management and improve results in the postoperative stages; however, there are still questions about its effects in the long-term. Objective  To evaluate the advantages and best practices for orally administrated isotretinoin in thick-skin rhinoplasty based on the current literature. Methods  An advanced search was conducted until August 31st, 2023, on the PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and LILACS databases with the keywords rhinoplasty and isotretinoin . Sixteen articles were reviewed and 4 met the inclusion criteria, with a total of 371 patients. Meta-analysis of the data collected was not possible due to heterogeneity among papers. Conclusion  Isotretinoin can be a safe drug, and its use in rhinoplasty varies widely, although all studies reported a low-dose oral regime for up to 6 months. The medication use is well-established in thick-skin rhinoplasty. Small doses after the procedure can improve patient satisfaction and the quality and thickness of the skin in the first 6 months of postsurgery. After 6 months, studies with a control group did not show a significant difference in patient satisfaction rates. A strong framework and specific surgical maneuvers may be more important than isotretinoin for better outcomes in thick-skin rhinoplasty.