Benefits and Safety of Isotretinoin in Rhinoplasty for Thick-Skinned Patients: A Systematic Review
Rammal A, Mogharbel A.
What this paper says
A systematic review finds isotretinoin after rhinoplasty in thick-skinned patients improves definition and satisfaction at three and six months, but the advantage over untreated patients fades by one year; dryness is common, systemic side effects rare, and topical forms work as well as oral.
Overview
Thick nasal skin blunts the definition surgery creates. The Saudi authors searched PubMed, Scopus, Web of Science and Cochrane to December 2024 for studies of isotretinoin around rhinoplasty, extracting regimen, outcomes and complications with two independent reviewers. The number of included studies is not stated in the abstract.
Sections of note
- Higher satisfaction with isotretinoin at 3 and 6 months; decline by 12 months.
- Reduced skin thickness and better nasal definition for up to 6 months.
- Differences between treated and control groups diminished by one year.
- Dryness common and manageable; systemic side effects rare.
- Oral and topical formulations showed similar efficacy; topical favoured for milder side effects. Level of Evidence I (as assigned).
What it means for a patient
- Isotretinoin can sharpen the early result in thick skin but does not appear to change the one-year outcome.
- Topical retinoid preparations may give the benefit with fewer risks than oral isotretinoin.
- Oral isotretinoin has serious side effects (birth defects, mood effects, impaired healing) and needs medical supervision.
Why this paper matters
It tempers enthusiasm for isotretinoin with a time-course: real early benefit, no lasting difference. Limits: number and quality of studies not given in the abstract; heterogeneous regimens.
Terms
- Isotretinoin: an oral retinoid that shrinks oil glands and thins skin.
- Thick-skinned nose: skin with a heavy sebaceous layer that hides underlying definition.
- Topical formulation: applied to the skin rather than swallowed.
- Nasal definition: visible separation of tip, bridge and side walls.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.
Abstract
Background: Rhinoplasty enhances nasal aesthetics and function but faces challenges in thick-skinned patients due to limited contour definition and higher risks of scarring and complications. Isotretinoin shows promise in reducing skin thickness and improving healing, but its side effects necessitate careful monitoring.
Aim: To consolidate existing evidence on isotretinoin efficacy, safety, and impact on satisfaction to guide decision-making for this patient population.
Methods: We retrieved relevant articles up to December 2024 from PubMed, Scopus, Web of Science, and Cochrane Library. Data were extracted from eligible studies by two independent reviewers, including baseline information, type of surgery, isotretinoin regimen, study outcomes, and complications.
Results: Higher satisfaction was found with isotretinoin use post-rhinoplasty at three and six months post-op; however, satisfaction often declined by 12 months. Isotretinoin improved cosmetic results, reducing skin thickness and enhancing nasal definition for up to six months. Nonetheless, differences in outcomes between intervention and control groups diminished by one year. Complications like dryness were common but manageable, while systemic side effects were rare.
Conclusion: Isotretinoin offers short-term benefits after rhinoplasty for thick-skinned patients, with diminishing effects by one year. Similar efficacy was noted for both oral and topical formulations, favoring topical formulations for their milder side effects.
Level Of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Abstract as indexed by PubMed; the article is open access (PubMed Central).
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