Tightening skin prior to rhinoplasty?

Question

Not sure if this is a question for a dermatologist or a plastic surgeon...but I'm considering a rhinoplasty next year and am worried about developing excess scar tissue under my skin (pollybeak) due to my skin not shrinking enough following the surgery. Theoretically, would using something like a topical retinol cream prior to surgery improve skin elasticity, and in turn, reduce the risk of excess scar tissue forming under skin that did not shrink well?

Jeffrey Lisiecki, MD · Answer

Question for a plastic surgeon, for sure, and someone who performs and is trained in rhinoplasty. Pollybeak is more an issue of inadequate or inappropriate tip support than anything, which is up to the technique of the surgeon performing the rhinoplasty. That being said, bringing the skin down to the framework of the nose is a key step in in rhinoplasty, which is done through several maneuvers during the surgery (supratip suspension sutures and alar base reshaping, for example). The place where topical treatments like retinoids are really helpful is in the setting of thick or sebaceous skin, where pre- and post-treatment helps control the skin envelope and ensure it responds to surgery appropriately. You should see a rhinoplasty surgeon and discuss your concerns. They evaluate you and help you develop a plan to meet your goals.

Zachary Farhood, MD · Answer

It really depends on the overall skin thickness and oiliness. If you have thick, oily skin and a history of severe acne, it is important not to reduce the size of your nose too much during rhinoplasty or you will experience some of the complications that you’re worried about. Recently many surgeons have begun to use Accutane to improve the skin appearance and shrink the sebaceous glands either before or after rhinoplasty (the decision is typically surgeon dependent). You need to have a consultation with your surgeon to fully determine how at risk you are for a polybeak deformity.

Ronald J. Edelson, MD · Answer

The concept of trying to pretreat the skin prior to rhinoplasty is not something that I think would be at all worthwhile. It certainly will not prevent polybeak from forming. Polybeak is caused by inadequate lowering of the bridge during surgery

Samuel Lin, MD, FACS · Answer

Great question and one that I would likely ask your dermatologist for any pre-procedure skin treatments.  "pollybeak" is a term that has been used for other reasons related to the procedure itself...

Robert Ciardullo, MD · Answer

Would retinol help your skin shrink better after rhinoplasty? The effect of retinol is very superficial and unfortunately would not improve your skins ability to contract after rhinoplasty or avoid scar tissue formation under the skin. Some people believe that taping might help after surgery, but the most effective treatment for scar tissue buildup in the supratip area following rhinoplasty is steroid injection.

William Portuese, MD · Answer

You do not have to worry about tightening skin prior to a rhinoplasty procedure. There are two causes of a poly beak. The first one is related to this swelling and edema in thick skin present in the supratip area. This is treated with a series of steroid shots after the surgery. The Second cause is when The surgeon leaves residual cartilage in that area. The Treatment for this is a revision touch up surgery to shave down excess cartilage

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
The pollybeak deformity is a condition where the supratip projects beyond the tip, creating a beak like projection. It may be natural or acquired (usually after previous rhinoplasty). It is caused by your genetics or may be due to excessive soft tissue scarring or inadequate bridge lowering during previous rhinoplasty.. It may be associated with a weak nasal tip. 
Skin elasticity can not be restored. Once the elastic fibers rupture, the effect is permanent.  In the majority of patients, the skin envelope usually adjusts and conforms to the underlying skeleton without any ancillary treatment. There are non-surgical modalities available to achieve skin tightening after surgery if necessary. I don't recommend preoperative application of a skin irritant. 
Visit a board certified plastic surgeon for evaluation and discussion.
Best wishes...

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