Download PDF
Facial Plast Surg
DOI: 10.1055/a-2247-5005
Original Research

Doxycycline Sclerodesis—“Rhinodesis”—for Enhanced Soft Tissue Adhesion in Rhinoplasty: A Preliminary Study

Milos Kovacevic
1   Department of ENT, Nasenaesthetik Hamburg Gerhofstraße 2 20354, Hamburg, Germany
,
Aaron M. Kosins
2   Irvine Department of Plastic and Reconstructive Surgery, Plastic and Reconstructive Surgery, University of California, California
,
Richard Davis
3   The Center for Facial Restoration, Miramar, Florida
4   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Miami School of Medicine, Miami, Florida
,
Salwa Al Maamari
5   Department of ENT/Facial Plastic Surgery, Sultan Qaboos University, Seeb, Oman
6   Department of Otolaryngology/Facial Plastic Surgery, University Hospital Lewisham, London, United Kingdom
,
Alwyn D'Souza
6   Department of Otolaryngology/Facial Plastic Surgery, University Hospital Lewisham, London, United Kingdom
› Author Affiliations
› Further Information
    Permissions and Reprints

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


Publication History

Accepted Manuscript online:
17 January 2024

Article published online:
08 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Garramone Jr RR, Sullivan PK, Devaney K. Bulbous nasal tip: an anatomical and histological evaluation. Ann Plast Surg 1995; 34 (03) 288-290 , discussion 290–291
    CrossrefPubMedGoogle Scholar
  • 2 Davis RE, Wayne I. Rhinoplasty and the nasal SMAS augmentation graft: advantages and indications. Arch Facial Plast Surg 2004; 6 (02) 124-132
    CrossrefPubMedGoogle Scholar
  • 3 Davis RE, Hrisomalos EN. Chapter 28–Hispanic secondary rhinoplasty (personal approach). In: Ghavami A, Most S, Cerkes N. eds. Global Rhinoplasty: A Multicultural Approach. New York, NY: Thieme; 2023: 276-290
    Google Scholar
  • 4 Davis RE, Hrisomalos EN. Surgical management of the thick-skinned nose. Facial Plast Surg 2018; 34 (01) 22-28
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Schreiber JE, Marcus E, Tepper O, Layke J. Discovering the true resolution of postoperative swelling after rhinoplasty using 3-dimensional photographic assessment. Plast Reconstr Surg Glob Open 2019; 7 (8, Suppl): 11-12
    CrossrefPubMedGoogle Scholar
  • 6 Zholtikov V, Kosins A, Ouerghi R, Daniel RK. Skin contour sutures in rhinoplasty. Aesthet Surg J 2023; 43 (04) 422-432
    CrossrefPubMedGoogle Scholar
  • 7 Bitik O, Uzun H, Konaş E, Reconstruction S. Scroll reconstruction: fine tuning of the interface between middle and lower thirds in rhinoplasty. Aesthet Surg J 2019; 39 (05) 481-494
    CrossrefPubMedGoogle Scholar
  • 8 Simon PE, Lam K, Sidle D, Tan BK. The nasal keystone region: an anatomical study. JAMA Facial Plast Surg 2013; 15 (03) 235-237
    CrossrefPubMedGoogle Scholar
  • 9 Hurewitz AN, Lidonicci K, Wu CL, Reim D, Zucker S. Histologic changes of doxycycline pleurodesis in rabbits. Effect of concentration and pH. Chest 1994; 106 (04) 1241-1245
    CrossrefPubMedGoogle Scholar
  • 10 Rodriguez-Panadero F, Montes-Worboys A. Mechanisms of pleurodesis. Respiration 2012; 83 (02) 91-98
    CrossrefPubMedGoogle Scholar
  • 11 Luria S, Applbaum Y, Weil Y, Liebergall M, Peyser A. Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts): case report of 4 patients. J Orthop Trauma 2006; 20 (06) 435-438
    CrossrefPubMedGoogle Scholar
  • 12 Sood A, Kotamarti VS, Therattil PJ, Lee ES. Sclerotherapy for the management of seromas: a systematic review. Eplasty 2017; 17: e25
    PubMedGoogle Scholar
  • 13 Burrows PE, Mitri RK, Alomari A. et al. Percutaneous sclerotherapy of lymphatic malformations with doxycycline. Lymphat Res Biol 2008; 6 (3–4): 209-216
    CrossrefPubMedGoogle Scholar
  • 14 Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS. The morel-lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop 2012; 2012: 593193
    PubMedGoogle Scholar
  • 15 Kosins AM. Comprehensive diagnosis and planning for the difficult rhinoplasty patient: applications in ultrasonography and treatment of the soft-tissue envelope. Facial Plast Surg 2017; 33 (05) 509-518
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kosins AM, Obagi ZE. Managing the difficult soft tissue envelope in facial and rhinoplasty surgery. Aesthet Surg J 2017; 37 (02) 143-157
    CrossrefPubMedGoogle Scholar
  • 17 Cobo R, Vitery L. Isotretinoin use in thick-skinned rhinoplasty patients. Facial Plast Surg 2016; 32 (06) 656-661
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Pikkel YY, Hasan MJ, Ben-Yehuda Raz D, Ben Naftali Y, Duek OS, Ullman Y. Morel Lavallée lesion - a case report and review of literature. Int J Surg Case Rep 2020; 76: 103-106
    CrossrefPubMedGoogle Scholar
  • 19 Gaillard F, Yap J, Mellam Y. et al. Morel-Lavallée lesion. Reference article, Radiopaedia.org (Nov 2009). Accessed January 24, 2024 at: https://doi.org/10.53347/rID-7532
    CrossrefPubMedGoogle Scholar
  • 20 Diviti S, Gupta N, Hooda K, Sharma K, Lo L. Morel-Lavallee lesions-review of pathophysiology, clinical findings, imaging findings and management. J Clin Diagn Res 2017; 11 (04) TE01-TE04
    PubMedGoogle Scholar
  • 21 Latifi R, El-Hennawy H, El-Menyar A. et al. The therapeutic challenges of degloving soft-tissue injuries. J Emerg Trauma Shock 2014; 7 (03) 228-232
    CrossrefPubMedGoogle Scholar
  • 22 Nickerson TP, Zielinski MD, Jenkins DH, Schiller HJ. The Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline. J Trauma Acute Care Surg 2014; 76 (02) 493-497
    CrossrefPubMedGoogle Scholar
  • 23 Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med 2007; 35 (07) 1162-1167
    CrossrefPubMedGoogle Scholar
  • 24 Kottmeier SA, Wilson SC, Born CT, Hanks GA, Iannacone WM, DeLong WG. Surgical management of soft tissue lesions associated with pelvic ring injury. Clin Orthop Relat Res 1996; (329) 46-53
    CrossrefPubMedGoogle Scholar
  • 25 Nair AV, Nazar P, Sekhar R, Ramachandran P, Moorthy S. Morel-Lavallée lesion: a closed degloving injury that requires real attention. Indian J Radiol Imaging 2014; 24 (03) 288-290
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Letournel E, Judet R, Letournel E, Judet R, Elson RA. Surgical approaches to the acetabulum. Berlin Heidelberg: Springer; 1993: 363-397
    Google Scholar
  • 27 Mooney M, Gillette M, Kostiuk D, Hanna M, Ebraheim N. Surgical treatment of a chronic Morel-Lavallée lesion: a case report. J Orthop Case Rep 2020; 9 (06) 15-18
    PubMedGoogle Scholar
  • 28 Godfrey KJ, Kally P, Dunbar KE, Campbell AA, Callahan AB, Lo C, Freund R, Lisman RD. Doxycycline Injection for Sclerotherapy of Lower Eyelid Festoons and Malar Edema: Preliminary Results. Ophthalmic Plast Reconstr Surg 2019; 35 (05) 474-477
    CrossrefPubMedGoogle Scholar
  • 29 Parra JA, Fernandez MA, Encinas B, Rico M. Morel-Lavallée effusions in the thigh. Skeletal Radiol 1997; 26 (04) 239-241
    CrossrefPubMedGoogle Scholar
  • 30 Chu E, Davis RE. SMAS debulking for management of the thick-skinned nose. JAMA Facial Plast Surg 2015; 17 (04) 305-306
    CrossrefPubMedGoogle Scholar
  • 31 Cakir B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
    CrossrefPubMedGoogle Scholar