Management and Limitations of Thick Skin in the Secondary Patient

Thick skin is a challenge in secondary rhinoplasty, frequently compromising both aesthetic outcomes and the predictability of surgical interventions. This article presents an integrated approach to the management of thick skin in patients undergoing secondary rhinoplasty. The described protocol encompasses preoperative, intraoperative, and postoperative strategies designed to reduce and control swelling, edema, and inflammation as much as possible. It incorporates topical and systemic medical therapies, dietary modifications, structured skin stretching exercises, and surgical techniques including superficial musculoaponeurotic system debulking, skeletal augmentation, structural grafting, and control of dead space formation.