FPS Facial Plastic Surgery · 2026

The Role of Oral Isotretinoin in Thick Skin Rhinoplasty: A Systematic Review

Yip HM, Fernandez-Carrera I, Chopra S, Paun S.

What this paper says

Across five studies, oral isotretinoin given around the time of rhinoplasty reduced skin thickness and improved appearance and satisfaction up to six months after surgery, with no major complications reported.

Overview

Thick nasal skin blunts tip definition and is the usual cause of a supratip bulge after surgery. Isotretinoin, the acne drug, thins oily skin. Two independent investigators searched the literature under PRISMA rules for studies of isotretinoin given before or after rhinoplasty in thick-skinned patients, looking at skin thickness, cosmetic outcome and satisfaction.

Sections of note

Systematic review conducted to PRISMA guidelines.
Two independent investigators ran the search and selection.
Five studies met inclusion criteria.
Outcome measures: skin thickness reduction, cosmetic surgical outcomes, postoperative patient satisfaction.
Findings: skin thickness reduced, cosmetic outcomes and satisfaction improved up to 6 months after surgery.
No major complications were reported in the included studies.
The authors call the evidence limited and ask for high-quality trials and a standard protocol.

What it means for a patient

This is a drug used off-label around surgery for a specific problem, thick oily tip skin, not for every patient.
Benefit was measured only to six months. Nothing here says whether the improvement lasts.
Five studies is a thin evidence base, and no standard dose or timing exists yet.
Isotretinoin carries known risks including severe harm in pregnancy; the abstract does not discuss dosing or screening.

Why this paper matters

Thick skin is the ceiling on what tip surgery can show, and surgeons have few tools against it. This review pools the small literature on a medical rather than surgical answer. What dose, for how long, and whether the effect holds past six months are all open.

Terms

Isotretinoin: an oral vitamin A derivative that shrinks oil glands and thins sebaceous skin.
Thick skin: a nasal skin envelope with high sebaceous content that hides underlying shape.
Supratip deformity: a bulge on the bridge just above the tip.
PRISMA: the reporting standard for systematic reviews.
Adjuvant: a treatment added alongside the main one.

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

From the abstract

“Thick skin poses a challenge in rhinoplasty, often resulting in an undefined tip and supratip deformities. Objectives And Hypotheses: This study evaluates oral isotretinoin as an adjuvant treatment for thick-skinned rhinoplasty patients. Study Design: This is a systematic review conducted in accordance with PRISMA…”

Excerpt; the full abstract is on PubMed.