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OPTIMISING RHINOPLASTY OUTCOMES IN PATIENTS WITH THICK SKIN
Kokand university, Andijan branch
Faculty of Medicine, General Medicine
Saydullayev ZiyodulloI lhomjon ugli
Scientific Instructor:
Ibragimov Farxod Azizovich
ziyodullosaydullayev92@gmail.com
Abstract.
Rhinoplasty is one of the most in-demand procedures in modern plastic surgery,
combining both aesthetic and functional goals.
This article explores current approaches to rhinoplasty, including open and closed
techniques, the use of autografts, and the role of 3D planning in preoperative preparation.
Special attention is given to the indications for surgical intervention, criteria for selecting the
method of correction, and prevention of complications. Patient satisfaction with surgical
outcomes and the impact of rhinoplasty on quality of life are also analyzed.
Modern trends in rhinoplasty aim to achieve natural results with minimal trauma while
preserving nasal function. Performing rhinoplasty on patients with thick skin often presents
a significant challenge. This article describes an assessment tool that classifies patients
based on skin thickness and demonstrates the clinical application of this classification in
preoperative evaluation.
Keywords.
Rhinoplasty, skin thickness, cosmetic surgery, skin thickness, chemical peel.
Introduction.
Undertaking rhinoplasty in patients with thick skin is a significant challenge
as the results can be unpredictable. This is the first study to examine the effects of stratifying
patients according to the thickness of their skin before plastic surgery. Practically speaking
the benefits of this classification is applied to identifying patients who would benefit from
preconditioning skin treatments as well as surgical manoeuvres to optimise their outcomes.
TCA peels have a proven efficacy in optimizing skin and has been used routinely in plastic
surgery to treat rhytids for many years. Traditional peels have used trichloroacetic acid or
Croton oil in a preprepared formula with an indicator solution to measure depth of
penetration. Courses are required to get training in this acid peel technique to avoid deep
burns and scarring.
Surgery is just one aspect of achieving patient satisfaction. Independent clinics routinely
refer patients in house for a range of non-surgical treatments to get the best result from
plastic surgery. Preconditioning is the safest way to treat thick skin rather than undertaking
surgical manoeuvres such as thinning the skin in theatre which can risk necrosis of the skin.
Given the importance of skin, it is remarkable that many plastic surgeons do not combine
plastic surgery with skin treatments. Current skin treatments used routinely before and after
surgery include Acid Peels, Morpheus8, Lymphatic drainage and laser treatments.
Combination treatment delivers the best results and this study aims to provide some
structure to stratify which patients will benefit the most.
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Factors Influencing Nasal Skin Thickness
Patient age, ultraviolet (UV) exposure, genetics and prior trauma are factors which should be
considered during the planning stage of rhinoplasty, due to their influence on the topography
of the Soft Tissue Envelope (STE). Increased patient age is associated with decreased
keratinocyte turnover, reducing its healing potential, as well as thinning of the dermis. The
dermis of Asian and Middle Eastern patients has more numerous collagen fibres and larger
fibroblasts, which explains its greater skin thickness. Collagen fibres are stacked more
closely with ground substance in black skin compared to white skin. These differences
between skin types are difficult to navigate, in Asian or Middle-eastern patients wishing for
western shaped nose after rhinoplasty. The stratum corneum is comparable between skin
types.
Thicker skin is associated with patients of African, Asian, and Middle Eastern backgrounds,
who have additional reconstructive considerations in that there is a tendency for weaker
cartilaginous support, making a defined tip even more technically challenging. Methods of
optimising postoperative results in patients with a thicker STE have included intraoperative
techniques such as thinning, altering the dissection plane as well as perioperative adjuncts
such as skin contour sutures. Perioperative strategies also include oral or intradermal
corticosteroid injections, chemical peels such as Trichloroacetic acid (TCA), and oral and
topical isotretinoin. An accurate preoperative assessment of the nasal STE thickness is
therefore crucial in operative planning, counselling patients, and in expectation management.
Although computer tomography (CT) and ultrasound imaging can be used to assess the soft
tissues, in practice most surgeons rely on clinical examination alone. There is evidently a
broad range of practice in optimising the soft tissue envelope, with no clear superior
technique, and no means of standardising outcome measures.
To our knowledge, there is also no standardised tool for assessing the nasal soft tissues
preoperatively. We therefore propose a photo-numerical scale for classifying the nasal STE
thickness prior to rhinoplasty. We have illustrated the application of this scale by grading
patients and allocating thicker STE grades into receiving preoperative TCA peels, as part of
the standard practice of the senior author (R.U.). The scale does not correlate with the
Fitzpatrick skin colour scale which relates to the response to UV exposure.
References
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