Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

Abstract

Objective: Understanding the postoperative dynamics of the nasal soft-tissue envelope (NSTE) is necessary to obtain the desired cosmetic results after rhinoplasty. This study was conducted to determine the changes of NSTE thickness and its effects on periorbital edema and ecchymosis following rhinoplasty. Methods: Thirty-five patients who underwent rhinoplasty were included in the study. Nasal skin and subcutaneous tissue thickness at the tip, supratip, rhinion, and nasion were measured using ultrasonography preoperatively and at the postoperative 3rd and 10th months. Periorbital edema and ecchymosis were evaluated at postoperative days 1, 3, and 7. The patients were categorized as the thick NSTE group (n ¼ 17) and the thin NSTE group (n ¼ 18) according to the preoperative median NSTE thickness. Results: In the thin NSTE group, supratip skin, subcutaneous tissue, and total NSTE thickness were lowest on the preoperative day but no statistically significant difference was found for the thick NSTE group. In the thin NSTE group, total NSTE thickness of the rhinion was highest at the postoperative 3rd month, but in the thick NSTE group, there was no statistically significant difference between postoperative 3rd and 10th months. In both groups, total NSTE thickness of the nasion was highest at the postoperative 3rd month and lowest at the postoperative 10th month. Conclusions: Supratip fullness occurs more prominent in patients with thin NSTE. Postoperative edema in the rhinion is greater in patients with thin NSTE for the early postoperative period but it lasts longer in patients with thick NSTE. Soft-tissue envelope atrophy at the nasion occurs in both groups in the late postoperative period. Periorbital edema and ecchymosis severity are not affected by NSTE thickness.

Dermatological assessment of thick‐skinned patients before rhinoplasty—what may surgeons ask for?

“… 1,3,6,9,13 A thick nasal skin seems to have less ability to contract and redrape on the OCF after a size reduction rhinoplasty, bearing a high risk to produce a smaller but amorphous nose 1,3,6,9 . Furthermore, the thickness of SSTE may affect the postoperative edema and supratip fullness 14 …”

“…1,3,6,9 Furthermore, the thickness of SSTE may affect the postoperative edema and supratip fullness. 14 Other features of the integument like seborrhea, porosity, pigmentation disorders, elasticity, sensitivity as well as the presence of dermal pathologies like rosacea, postinflammatory hyperpigmentation (PIH), or acne should be assessed preoperatively, since these conditions may worsen after surgery. 1,3,9 A thin SSTE may be modified surgically through camouflaging and augmentation techniques with fascia or fat transfer.…”