Invited Discussion on: The Role of Skin Thickness in the Choice of a Rhinoplasty Technique for Thin-Skinned Patients: An
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EDITOR’S INVITED COMMENTARY
Invited Discussion on: The Role of Skin Thickness in the Choice of a Rhinoplasty Technique for Thin-Skinned Patients: Analysis of Long-Term Results and Patient Satisfaction Kirill P. Pshenisnov1,2
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Kirill K. Pshenisnov2
Received: 24 May 2020 / Accepted: 26 May 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Publications of studies with a high level of evidence are very rare in plastic surgery literature. The authors did a great job selecting appropriate and valuable cohorts of patients with thin skin to find the best material to camouflage nasal dorsum and tip irregularities after primary open rhinoplasty with a long-term follow-up for more than 2 years. A total of 101 patients who underwent primary open rhinoplasty between January 2016 and March 2018 were analysed. The authors state that the mean follow-up time was 2.5 years (range, 2–7 years). If so, the date of submission of the manuscript should be at least the year of 2023, but not 2020 (2023–2016 = 7 years). Their criteria for thin skin were the Obagi pinch test with mean 0.3 mm Kosins ultrasonography measurement at the keystone area [1]. It is known that the soft tissue envelope of the nose consists of four layers. There is no description in the article of each of those layers including skin, subcutaneous fat, SMAS and perichondrium/periosteum that can differ in different patients. As mentioned, the authors have chosen camouflage instead of mastering appropriate techniques for the
& Kirill P. Pshenisnov [email protected] 1
Division of Plastic Surgery, European Medical Center, 7 Orlovsky Per., Moscow, Russian Federation 129110
2
Yaroslavl State Medical University, Yaroslavl, Russian Federation
maximal dorsum and soft tissue envelope preservation during primary procedures. Group 1 Diced cartilage taken from the septum was applied with drops of venous blood. This is an excellent plastic material gaining popularity even without Surgicel or fascia coverage especially during the last decade [2–4]. Unfortunately, the size of the cartilage chips preventing their palpability is not indicated. Soft tissue layers are not distinguished on Scheme 1. Differences in the soft tissue thickness are not shown on the drawing (radix, keystone, supratip, tip). The domes anatomical projection is also inadequate there. The fate of the Pitanguy ligament is unclear: saved or resected. This layer is important for the supratip break because simple cutting down results in Polly beak deformity [5]. Group 2 Fat injections for the enhancement of thickness of the soft tissue envelope seem to be the easiest of the selected camouflage procedures with minimal donor site morbidity. There are no comments in
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