Abstract
The use of doxycycline as a sclerosing agent is well-established. Given the clinical
efficacy of doxycycline sclerosant therapy, we embarked upon a study to evaluate the
efficacy of small-volume liquified doxycycline particularly in thick skinned rhinoplasty
patients to promote re-adhesion of the nasal skin-soft tissue envelope (SSTE) thereby
minimizing surgical dead space and enhancing surface contour, to improve the eventual
outcome of surgery.
We present two clinical case series using rhinodesis. All patients were treated with
the same rhinodesis protocol that included conventional splinting and taping. The
first series consisted of 102 consecutive primary rhinoplasties with medium to thick
nasal skin treated via open rhinoplasty. Doxycycline solution at a concentration of
20 mg/mL was applied beneath the skin flap using a 14-gauge angiocath inserted through
small gaps in the marginal suture line following closure, retained for 2 to 3 minutes,
and then expressed from the dead space. Firm manual compression of the SSTE was maintained
for at least 1 additional minute, and the splint was then applied. The second series
consisted of 25 thick-skinned primary rhinoplasties that were also treated with open
rhinoplasty using the same rhinodesis protocol. However, the second group was evaluated
with serial postoperative ultrasonography to characterize the soft-tissue response
to rhinodesis, particularly within the tip and supra-tip regions.
Results revealed enhanced skin adherence in nearly all patients when compared to traditional
taping and splinting alone. Ultrasonic examination demonstrated enhanced adherence
of the subcutaneous tissue to the nasal framework and suggests that rhinodesis is
effective at minimizing dead space in majority of thick-skinned rhinoplasty patients.
No complications were observed. Doxycycline can be used easily and safely to seal
the surgical dead space post-rhinoplasty and minimize degradation of nasal contour
with excellent outcome.
Keywords
doxycycline Sclerodesis - doxycycline - rhinodesis - skin-soft tissue envelope
