The Role of Skin Thickness in the Choice of a Rhinoplasty Technique for Thin-Skinned Patients: Analysis of Long-Term Results and Patient Satisfaction

Overview

Thin nasal skin lets every edge of the underlying framework show, so surgeons place a camouflage layer over the bridge. This randomized study compared three camouflage materials against no camouflage, following patients for at least two years.

Sections of note

• Inclusion required primary rhinoplasty, thin skin, at least 2 years of follow-up, standard before and after photography, understanding of Italian, and a signed consent form.
• Four randomized groups: diced cartilage, lipofilling, temporal fascia graft, and a control group with no camouflage.
• Patients answered the Italian FACE-Q rhinoplasty module; nasal skin thickness was measured with the Obagi skin pinch test.
• Two plastic surgeons rated all postoperative photographs on a 1 to 5 scale.
• 101 patients operated between January 2016 and March 2018 were enrolled; mean age 38.5 years; mean follow-up 2.5 years.
• Only group 1, diced cartilage, showed significant preoperative to postoperative FACE-Q improvement, P below 0.01, and its results remained stable over long-term follow-up, P below 0.01.
• Groups 2 and 4, lipofilling and control, underwent more secondary procedures than groups 1 and 3, P below 0.01. Level of evidence I.

What it means for a patient

• Thin skin needs something between it and the framework, and doing nothing led to more second operations.
• Diced cartilage was the only option showing measurable satisfaction improvement that lasted.
• Fat injection performed no better than doing nothing on the secondary procedure measure.
• Limits: 101 patients across four groups, one department, and the abstract contains an inconsistency in one comparison statement.

Why this paper matters

Camouflage choice for thin skin is usually a matter of surgeon preference, and this is presented as the first randomized comparison with over two years of follow-up. A level I design in rhinoplasty is rare. The four-group split means each arm is small.

Terms

• Thin-skinned: Having a thin nasal soft tissue covering that reveals the framework beneath.
• Diced cartilage: Cartilage cut into very small pieces and used as a mass.
• Lipofilling: Injecting the patient's own fat to add volume.
• Temporal fascia graft: A sheet of fibrous tissue taken from the temple.
• FACE-Q: A modular validated questionnaire covering facial appearance outcomes.
• Obagi skin pinch test: A clinical test estimating skin thickness by pinching it.