ORAL ISOTRETINOIN IN AESTHETIC RHINOPLASTY FOR PATIENTS WITH THICK SKIN: EVIDENCE, SAFETY, DOSE, AND OPTIMAL TIMING OF USE

Abstract

Introduction: Thick nasal skin remains one of the main determinants of limited tip definition, prolonged postoperative edema, and delayed aesthetic refinement after rhinoplasty. Oral isotretinoin has been proposed as an adjuvant therapy because of its effects on sebaceous gland activity, keratinization, dermal behavior, and nasal skin thickness, but concerns persist regarding wound healing, mucosal dryness, scarring, and optimal perioperative timing. Objective: The main objective of this systematic review was to evaluate the efficacy and safety of oral isotretinoin in aesthetic rhinoplasty patients with thick nasal skin. Secondary objectives were to assess its effects on postoperative edema, nasal skin thickness, skin quality, tip definition, patient satisfaction, dose strategies, timing of initiation, adverse events, and certainty of evidence. Methods: PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched using terms related to rhinoplasty, isotretinoin, thick nasal skin, nasal skin thickness, postoperative edema, wound healing, and aesthetic outcomes. The primary eligibility window was five years, expanded to ten years for direct clinical studies because fewer than 10 primary rhinoplasty studies were available. Direct studies of isotretinoin in rhinoplasty patients and supportive human evidence on nasal skin thickness, retinoid procedural safety, wound healing, and isotretinoin monitoring were included in a qualitative synthesis. Results and Discussion: Twelve studies were included in the final qualitative synthesis. Direct rhinoplasty studies suggested that oral isotretinoin may improve early postoperative appearance, skin quality, sebaceous activity, nasal skin thickness, and patient satisfaction in selected thick-skinned patients. The most consistent benefit was observed during the first postoperative months, whereas evidence for superior final aesthetic outcomes at 12 months or longer remained limited. Supportive literature challenged the traditional absolute avoidance of procedures during or soon after isotretinoin therapy, but rhinoplasty-specific safety data remained underpowered for uncommon complications. The certainty of evidence was low for early cosmetic improvement and nasal skin thinning, and very low to low for optimal dose, timing, duration, and long-term aesthetic superiority. Conclusion: Oral isotretinoin may be considered a selective adjuvant in thick-skinned rhinoplasty patients, especially when sebaceous activity, prolonged edema, or skin thickness is expected to limit early refinement. Its use should be individualized, preferably low dose, delayed until early epithelial stability when clinically appropriate, and monitored jointly by the surgeon and dermatologist. Current evidence supports cautious, multidisciplinary use rather than routine prescription for all thick-skinned rhinoplasty patients.