Optimizing Rhinoplasty Outcomes: The Role of Isotretinoin and Patient Management Strategies: Systematic Review.

[BACKGROUND] Rhinoplasty outcomes in patients with thick nasal skin may be challenging due to the sebaceous nature of the skin, which can compromise tip definition and delay resolution of postoperative edema. Perioperative adjunct using isotretinoin is suggested as a well-established treatment for acne and sebaceous hyperactivity.

[METHODS] We conducted this systematic review in accordance with PRISMA guidelines. Literature searches were performed in PubMed, Scopus, Web of Science, and Embase databases for studies published up to March 2025. Search strategies incorporated combinations of keywords relating to "rhinoplasty," "isotretinoin," "nasal skin," and "wound healing." Eligible studies included randomized controlled trials (RCTs), cohort and retrospective studies, with human participants undergoing rhinoplasty with or without systemic or topical isotretinoin, reporting on outcomes such as skin thickness, edema, patient satisfaction, wound healing, and complications. Risk of bias and quality assessment were assessed with the Joanna Briggs Institute (JBI) critical appraisal tools.

[RESULTS] This systematic review included seven eligible studies-all with human participants-three RCTs, three retrospective cohort studies, and one prospective cohort study. We found that isotretinoin improved nasal tip definition, decreased postoperative edema, and improved patient satisfaction. Specific studies reported a marked reduction in sebaceous gland activity, and shaved-off nasal skin thickness was considered responsible for the more refined aesthetic outcome. No significant adverse effects other than mild mucosal dryness and transient cheilitis were observed; it seemed to accelerate wound healing. However, causality within isotretinoin use could not be established in some studies, and some needed revision surgery.

[CONCLUSION] Isotretinoin administration, particularly when individualized by patient profile, appears to significantly improve both aesthetic and wound-healing outcomes in rhinoplasty patients with thick nasal skin and displays a favorable safety profile under close monitoring. Further large-scale RCTs are required to optimize dosage and perioperative protocols.