Optimizing External Nasal Splinting Protocols Following Rhinoplasty in Thick-skinned Indian Noses: A Retrospective Comparative Study

The thick sebaceous skin characteristic of the Indian nasal phenotype presents a significant challenge during surgery in rhinoplasty, often leading to prolonged postoperative edema and loss of tip definition. This study aims to evaluate the efficacy of an optimized, prolonged external nasal splinting protocol in improving aesthetic outcomes and patient satisfaction among Indian patients compared with traditional short-duration splinting. A retrospective comparative study was conducted at a plastic surgery center in Chennai, involving 50 Indian patients who underwent open rhinoplasty between January 2024 and January 2025. Patients were divided into two cohorts: Group I (n = 25) wore an external splint for 7 days, while Group II (n = 25) followed a prolonged protocol (24 hours for 2 weeks, followed by 8 hours daily for 2 months). Both the groups received 10 mg of isotretinoin twice daily for 6 months postoperatively to modulate skin thickness. Outcomes were assessed using the rhinoplasty outcome evaluation (ROE) questionnaire preoperatively, and at 3 and 6 months postoperatively. Data analysis was performed using Epi Info (7.2.2.2). Quantitative variables were compared using t-tests, and categorical variables were analyzed via the Chi-square test. A p-value of <0.05 was considered statistically significant. At the 3-month follow-up, Group II demonstrated significantly higher mean ROE scores compared with Group I (p < 0.0001). This statistical significance persisted at 6 months (p < 0.0001). Group I patients frequently exhibited persistent tip edema and a “spindle-shaped” deformity. In contrast, Group II patients achieved superior tip definition, sharper contours, and higher overall satisfaction. For the thick-skinned Indian nose, traditional short-term splinting is often insufficient to control postoperative dead space and edema. An optimized protocol combining prolonged external splinting for 2 months with adjuvant isotretinoin therapy significantly enhances nasal tip definition and patient-reported outcomes. We advocate for this tailored postoperative regimen to achieve predictable and refined results in this specific demographic.