Effectiveness of Isotretinoin Administration in Rhinoplasty: A Systematic Review

Overview

Thick nasal skin masks the refinements made beneath it, and isotretinoin, an oral vitamin A derivative, thins skin and reduces oil gland activity. The authors searched Medline, Embase, Cinahl, Central, Scopus and Web of Science in June 2024 for original research in adults who had rhinoplasty and received isotretinoin before or after surgery, excluding case reports and small series.

Sections of note

• Design: systematic review using the Population Intervention Comparison Outcome framework.
• Six studies were identified: 3 retrospective studies and 3 randomized controlled trials.
• Four studies showed improvement in patient aesthetic satisfaction up to at least 6 months after surgery.
• Only two studies showed sustained improvement to one year, and both lacked control groups.
• Stated reasons effectiveness could not be determined: inconsistent treatment protocols, inconsistent outcome measures, absent control groups and short follow up.
• The conclusion describes the results as promising but indeterminate.
• No pooled effect sizes, doses, timing or complication data appear in the abstract.

What it means for a patient

• The evidence base is six studies, and the two showing benefit lasting a year had no comparison group.
• Half the included studies were randomized trials, which is unusually high for this field, but the studies used different protocols so they cannot be combined.
• No dosing or timing guidance emerges from this review, so how the drug would be used remains unsettled.
• Isotretinoin has significant side effects, including strict avoidance in pregnancy, which the abstract does not discuss.

Why this paper matters

Thick skin is one of the strongest limits on rhinoplasty results, and no established medical treatment addresses it, so any drug that thins skin attracts attention. This review tests the enthusiasm against the evidence and finds it unproven. Consistent protocols with control groups and longer follow up are what would settle it.

Terms

• Isotretinoin: an oral vitamin A derivative used to treat severe acne.
• Thick nasal skin: a heavy skin envelope that masks underlying nasal shape.
• Systematic review: a structured search and appraisal of all studies meeting set criteria.
• PICO framework: a method of framing a research question by population, intervention, comparison and outcome.
• Randomized controlled trial: a study where patients are randomly assigned between treatments.
• Control group: a comparison group not receiving the treatment being tested.