Skin and Soft Tissue Management in Primary Rhinoplasty

Aims and Backgrounds: Rhinoplasty outcomes are determined by the complex interplay of modifications to both the osseocartilaginous framework and the behavior of the overlying skin-soft tissue envelope (SSTE). Successful surgery demands attention to several soft tissue characteristics including skin thickness, elasticity, sebaceous content, and fibrous ligamentous attachments, which together influence tip definition, support, and long-term aesthetic outcomes. Aims and Backgrounds: This review summarizes evidence-based principles and practical strategies for soft tissue management in primary rhinoplasty. By integrating anatomical knowledge, meticulous surgical technique, and attentive postoperative management, surgeons can enhance tip definition, minimize complications, and achieve durable, aesthetically satisfying results. Emphasizing both structural and soft tissue considerations provides a comprehensive framework for optimizing rhinoplasty outcomes through thoughtful SSTE management. Historical Aspects: This article thoroughly reviews the body of literature on skin and soft tissue management in primary rhinoplasty, providing a historical and contemporary account on this complex topic. Anatomy: The surgeon's understanding of nasal anatomy continues to evolve since the advent of facial plastic surgery. This review provides a detailed description of all the layers of the nose and how they relate to surgical considerations in rhinoplasty. Current and Future Development: This review provides both current and future insight into the management of skin and soft tissue management in rhinoplasty largely centered around strong understanding of nasal anatomy, soft tissue analysis and preservation, and refined grafting techniques. Conclusion and Clinical Relevance: Contemporary rhinoplasty has shifted away from a "one-size-fits-all" approach and more toward a deliberate and methodical approach based on the biochemical, structural, and nuanced subtleties of the nasal SSTE that makes every nose a unique challenge. This review hopes to inform readers on the many complexities that must be taken into account in rhinoplasty with the goal of supplementing the modern surgeon's intellectual toolbox when approaching this challenging surgery.