When should rhinoplasty Isotretinoin be used?
Considering that the drug containing the active ingredient Isotretinoin, which is commonly used in the treatment of moderate and severe acne (pustule) for the last 30 years, leads to abnormal scar formation and delayed wound healing, it is recommended to postpone the interventional surgery of the skin or the
traumatic procedures of the skin to the end of treatment.
There is no high-quality, evidence-based study in the literature on the need for surgical procedures when receiving this drug treatment or how long after treatment is discontinued, or the existing studies are very limited.
The regional medical problems expected to meet in trauma field with systemic Isotretinoin include delay in wound healing on the skin (due to the scar/ suture separation or infection?) and pathologic (apparent scar) healing problems.
In the studies carried out since the mid-1980s, it was emphasized that among the plastic surgery practices, mechanical skin resurfacing (dermabrasion) and ablative(peeling) laser treatments should not be performed during Roaccutane treatment and within the first year following the end of treatment.
Now the parameters have changed.
The study that indicates the problem of any scar healing or delay was not encountered in patients after any other upper eye lid, rhytidoplasty aesthetic, biopsy and liposuction in the treatment of Isotretinoin (Roaccutane) treatment draws attention. In the treatment of moderate / severe acne, it is recommended
that traumatic session procedures should be performed 6-12 months after isotretinoin treatment on one side of the scale, while on the other side there will be severe psychosocial sequelae caused by delayed treatment. The communication of qualified and sufficient medical doctor/patient will be necessary when
deciding in this situations.
It is recommended that isotretionin drug treatment should not be started for2 years after rhinoplasty by putting forward to the study conducted by Allen and Rhee in 2005, Isotretinoin treatment, which was started 7-24 months after Rhinoplasty in 3 patients, caused nasal tip deformities (nasal tip cartilage due
to skin shrinkage and withdrawal), cartilage irregularities, etc.
Mysore suggests in study published in 2017 that during the treatment of Isotretinoin; Laser epilation, Dermaroller, Radiofrequency, superficial / moderate depth resurfacing, microdermabrasion, superficial skin procedures (the removal of the spot, biopsy etc.), superficial laser treatments for the purpose of acne and skin resurfacing are secure. However, deep tissue surgery (Rhinoplasty?), deep skin peeling and laser procedures should be done after waiting for 6 months.
My personal recommendation is the same as the standard accepted book information and FDA advice.
Do not undergo surgery during the treatment and “wait 6 months for surgery after the end of treatment. I suggest that the Rhinoplasty surgery should be planned for 2 main reasons after 6 months following the treatment other than privileged emergency situations. The first reason is the improvement of structural
damage caused by the drug to the skin and mucous membranes (such as bleeding due to dryness in the nose) and the risk of latent depression caused by the chemical. As was known, Rhinoplasty needs strong psychological stability with image converting effect.
– Mahadevappa OH, Mysore V, Viswanath V. Surgical outcome in patients taking concomitant or recent intake of oral isotretinoin: a multicentric study-ISO-AIMS study. J Cutan Aesthet Surg. 2016;9 (2):106- 114
– Allen BC, Rhee JS. Complications associated with isotretinoin use after rhinoplasty. Aesthetic Plast Surg. 2005;29(2):102-106.
– Mysore V., Mahadevappa O.H., Barua S., Majid I., Viswanath V., ve ark. J Cutan Aesthet Surg. 2017 Oct- Dec;10(4):186-194. Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin.
