Evaluation of Skin-Soft Tissue Envelope Thickness by Ultrasonography after Primary and Revision Rhinoplasty

Overview

Excessive swelling after rhinoplasty thickens the skin and soft tissue covering and blurs the definition of the underlying framework. Revision operations are suspected of causing more swelling. This study compared measured covering thickness after revision against first time surgery in patients from one private clinic over a 12 month period, all having open approach rhinoplasty.

Sections of note

• Study of 36 participants; the journal assigns level of evidence III.
• Thickness was measured by ultrasound at the nasion, rhinion, supratip and tip.
• Measurements were taken at 1, 3, 6 and 12 months after each operation.
• Paired comparisons were made between corresponding regions and times for primary and revision surgery.
• The covering was significantly thicker after revision surgery at all follow up sessions and regions.
• The exceptions were the 1 month measurement at the nasion, P equals 0.273, and the 12 month measurement at the rhinion, P equals 0.050.
• Mean thickness decreased over time after both types of surgery.
• Resolution was slower at the nasion after revision surgery, P less than 0.001.

What it means for a patient

• Swelling after a second operation is both greater and slower to settle than after a first.
• Thickness was measured objectively by ultrasound rather than judged by eye.
• The persistent thickening blurs the definition the surgery was intended to create.
• Thirty six patients from one clinic, all treated by the same surgeon, is a small sample.

Why this paper matters

Patients are commonly told swelling resolves within a year, and this study shows that timeline differs after revision surgery. It quantifies the difference region by region. Whether the residual thickness reflects swelling or permanent scar is not distinguished.

Terms

• Skin soft tissue envelope: the skin, fat and muscle covering the nasal framework.
• Ultrasonography: imaging using sound waves, here to measure tissue thickness.
• Nasion: the point at the root of the nose between the eyes.
• Rhinion: where the nasal bones meet the cartilage on the bridge.
• Supratip: the area of the bridge just above the tip.
• Edema: swelling from fluid in the tissues.