Oral Isotretinoin in the Treatment of Postoperative Edema in Thick-Skinned Rhinoplasty: A Randomized Placebo-Controlled Clinical Trial

Sazgar AA, Majlesi A, Shooshtari S, Sadeghi M, Sazgar AK, Amali A.

What this paper says

In a randomized placebo-controlled trial of 48 thick-skinned rhinoplasty patients, oral isotretinoin gave significantly better cosmetic results at 3 and 6 months, but no difference remained at 12 months.

Overview

Thick nasal skin masks the shape of the framework underneath and holds swelling for longer. Oral isotretinoin, an acne drug that reduces oil gland activity and thins skin, has been proposed as a postoperative aid. This double-blind trial tested whether it changes the cosmetic result.

Sections of note

Double-blind placebo-controlled clinical trial; 48 cases randomly divided into two groups.
Group 1 started oral isotretinoin 0.5 mg per kg on the 31st day after surgery, given every other day for 1 month, then daily for two further months.
Group 2 received placebo in the same form, sequence and interval.
Cosmetic results were assessed by patient satisfaction and by ranking from an expert surgeon.
Comparisons were made at 3 months, 6 months and 1 year after surgery.
The isotretinoin group scored significantly better at 3 and 6 months on both measures, p below 0.05.
At 12 months there was no statistically significant difference between the groups, p above 0.05. Level of evidence II.

What it means for a patient

The drug sped up the visible improvement but did not change where the nose ended up after a year.
Treatment started a month after surgery and ran for three months.
Isotretinoin requires monitoring and carries known side effects, none of which are reported in this abstract.
Limits: 48 patients in two groups, one center, and cosmetic outcome judged by patient report and a single expert surgeon rather than objective measurement.

Why this paper matters

Thick skin is the variable surgery cannot directly change, and previous reports of isotretinoin were uncontrolled. A randomized placebo-controlled design gives a clearer answer. The answer is that the benefit is to the pace of recovery, not the final result.

Terms

Isotretinoin: An oral vitamin A derived drug that reduces oil gland activity and thins skin.
Edema: Swelling caused by fluid in tissue.
Placebo-controlled: Compared against an inactive treatment given the same way.
Double-blind: Neither patients nor assessors knew who received the active drug.
Level of evidence II: A ranking indicating a well-conducted randomized trial.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“The thick-skinned nose is still one of the most challenging aspects of rhinoplasty. The possible effects of oral isotretinoin on cosmetic results of rhinoplasty in patients with thick nasal skin have been considered during recent years. Methods: In this double-blind placebo-controlled clinical trial, 48 cases were…”

Excerpt; the full abstract is on PubMed.