FPS Facial Plastic Surgery · 2026

Skin and Soft Tissue Management in Primary Rhinoplasty

Eskander PN, Crawford KL, Loyo M.

What this paper says

A review arguing that the skin envelope, not only the bone and cartilage under it, decides the result of a first-time rhinoplasty, and setting out how surgeons should read and handle it.

Overview

The authors review skin and soft tissue management in primary rhinoplasty. Their case is that the result comes from the interaction between changes to the framework and the behaviour of the covering skin. The review covers the anatomy layer by layer, the history of the topic, and current and future practice. It reports no patient series and no numbers.

Sections of note

The skin-soft tissue envelope is described through four characteristics: thickness, elasticity, sebaceous content, and fibrous ligamentous attachments.
Those characteristics are said to influence tip definition, tip support and how the result holds over time.
The review sets out each layer of the nose and how it bears on surgical decisions.
It covers historical and contemporary literature on the subject.
Future direction given as soft tissue analysis and preservation plus refined grafting technique.
Conclusion: contemporary rhinoplasty has moved away from a one-size-fits-all approach.

What it means for a patient

Skin thickness is a large part of why two patients with the same operation can look different, and it is not something the surgeon can change much.
Thick, oily skin hides fine work on the tip; thin skin shows every edge underneath.
This is a teaching review. It offers no outcome data and no comparison of techniques.

Why this paper matters

Skin quality is the variable surgeons cannot alter and patients rarely hear about at consultation. The review assembles what is known. It does not settle which specific soft tissue techniques change results, which would need trials rather than review.

Terms

Primary rhinoplasty: a first nose operation, as opposed to a revision.
Skin-soft tissue envelope (SSTE): the skin, fat, muscle and lining draped over the nasal framework.
Sebaceous: oil-gland-rich, a feature of thick nasal tip skin.
Ligamentous attachments: fibrous bands tethering the skin to the cartilage.
Tip definition: how sharply the tip shape shows through the skin.

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

From the abstract

“Rhinoplasty outcomes are determined by the complex interplay of modifications to both the osseocartilaginous framework and the behavior of the overlying skin-soft tissue envelope (SSTE). Successful surgery demands attention to several soft tissue characteristics including skin thickness, elasticity, sebaceous content,…”

Excerpt; the full abstract is on PubMed.