Comparison of Postoperative Edema Between Sub-SMAS and Subperichondrial Dissection Planes in Rhinoplasty Using Ultrasonographic Skin Thickness Measurements

Overview

Surgeons lift the nasal skin in one of two layers: under the SMAS (the fibromuscular layer) or deeper, directly on the cartilage covering. The Turkish authors randomised 44 rhinoplasty patients to each plane and measured skin thickness at tip, supratip and dorsum by ultrasound before surgery, at one week and at one month.

Sections of note

• Dissection time 13.3 (SD 1.4) minutes subperichondrial versus 12.5 (SD 1.4) sub-SMAS (p = 0.05).
• Baseline thickness equal at all sites.
• Week 1: subperichondrial thinner at tip (p = 0.024) and supratip (p = 0.027); dorsum no difference (p = 0.13).
• Percentage increase in thickness higher with sub-SMAS at tip (p < 0.001) and supratip (p = 0.027).
• Month 1: no differences at any site. Level of Evidence I.

What it means for a patient

• The deeper dissection plane reduces early tip swelling, so the nose looks more settled in the first weeks.
• By a month the two planes were equal; there is no evidence here of a long-term difference.
• The deeper plane adds under a minute to surgery.

Why this paper matters

It uses objective ultrasound in a randomised design to test a claim central to preservation-style dissection. Limits: 44 patients, one-month endpoint, single centre.

Terms

• SMAS: superficial musculoaponeurotic system, the fibromuscular layer under nasal skin.
• Sub-SMAS plane: dissection beneath the SMAS but above the perichondrium.
• Subperichondrial plane: dissection directly on the cartilage, beneath its membrane.
• Supratip: the area just above the tip.
• Oedema: swelling.