Isotretinoin in Thick-Skin Rhinoplasty: A Review.

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.  To evaluate the advantages and best practices for orally administrated isotretinoin in thick-skin rhinoplasty based on the current literature.  An advanced search was conducted until August 31st, 2023, on the PubMed, Cochrane Library, ClinicalTrials.gov, Embase, and LILACS databases with the keywords and . 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.  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.