Dispelling the Myths of Isotretinoin and Implications for Rhinoplasty.

Summary: Despite concerns from 1980s case reports, oral isotretinoin, a derivative of vitamin A, has largely proven to be safe in surgical procedures, with the exception of deep skin resurfacing. Isotretinoin modulates thinning skin and internal scarring in select rhinoplasty patients who may otherwise have poor definition and excessive scarring. A review of patients undergoing surgical interventions, including rhinoplasty, in the setting of concomitant isotretinoin use was performed to examine safety and therapeutic potential. A total of 49 studies were reviewed. Isotretinoin use appears to be safe in a wide variety of surgical procedures relying on internal scar formation. In rhinoplasty, oral isotretinoin was used to thin skin and improve appearance, and resulted in patient and surgeon satisfaction. As such, the clinical potential for using oral isotretinoin in select rhinoplasty candidates-such as those with thick, glaborous, sebaceous skin; male sex; certain races or ethnicities; or revision cases-could mitigate internal scarring processes. Further studies examining the optimal dosing regimen and long-term benefits are warranted.