Use of Isotretinoin Capsules (Roaccutane / Zoretanin) Before and After Rhinoplasty

Use of Isotretinoin Before Nose Surgery in Patients With Thick and Pimply Skin

Isotretinoin, Roaccutane, Zoretanin, Aknetrent, Acnegen, Thick skinned nose, Oily ethnic nose

Can patients who use drugs containing isotretinoin have rhinoplasty or nose tip surgery? 

Patients who use isotretinoin capsules for acne treatment or because they have thick oily nasal skin should not undergo rhinoplasty. Although rare; it may cause an increase in liver enzymes in patients. Low dose (10-20 mg) users are less likely to have side effects on the liver. It may be useful to check liver enzymes while performing surgical examinations before rhinoplasty operation.

Should the use of capsules containing isotretinoin be discontinued before nose surgery?

It may be appropriate for patients who normally use this medication to stop using it one week before surgery. The drug can be restarted 1 week after the operation process is completed. It may be appropriate for the dermatology doctor and the surgeon performing the rhinoplasty operation to decide together regarding the dosage and the start of the medication. In terms of drug side effects, there may be an increase in nasal dryness and it may be appropriate to use more intranasal moisturizing products in the early postoperative period.

How does the use of medications containing isotretinoin affect the outcome of the surgery? 

In patients with thick and oily skin, abnormal swelling and a rounded nasal tip may appear during the healing process after surgery. There may be significant differences between the photographs taken immediately after the rhinoplasty operation and the photographs taken a few months later. For example, the nose may appear larger and rounder despite the surgery, and abnormal fibroadipose tissue production in the supratip region and nasal tip may cause a low nasal tip and beak nose derformity. Due to the edema around the cartilage grafts placed by the surgeon during surgery, a large and swollen nose may appear unrelated to the photograph taken immediately after surgery. The use of isotretinoin capsules in patients with acne and oily skin may lead to a successful surgical result. 

Products containing isotretinoin in Turkey and generic names

Medicines containing isotretinoin available in Turkey:

ACNEGEN Capsules (10mg and 20mg available), AKNETRENT Capsules (10mg and 20mg available), ROACCUTANE Capsules (10mg available), ZORETANIN Capsules (10mg and 20mg available). Roaccutane is the most known product but it is not available in Turkey nowadays. 

Zoretanin tb
I usually prescribe Zoretanin 20mg capsule which is an FDA approved product (Actavis Introduces Two New Products in Turkey | FDAnews).

Zoretanin tb

Indications for products containing isotretinoin 20mg capsules

This product is indicated for the treatment of severe forms of acne (nodular or conglobate acne, or acne with the risk of permanent scarring) and acne that does not respond to standard treatments with systemic antibacterial and topical therapy. It can also be used to reduce or thin fibroadipose tissue in noses with thick skin structure, before and after rhinoplasty operation.

Isotretinoin 20mg capsules usage dosage

Proposed therapeutic response and adverse effects are dose-dependent and vary in patients. 

For the treatment of acne: This requires individual dose adjustment for each patient during treatment. isotretinoin treatment should be started at a dose of 0.5 mg/kg per day. For most patients, the dose varies between 0.5-1.0 mg/kg per day. Higher doses of up to 2.0 mg/kg may be required in patients with very severe disease or acne on the body. A cumulative therapeutic dose of 120-150 mg/kg bw has been shown to increase remission rates and prevent relapse. Therefore, the duration of treatment in each patient varies according to the daily dose. Acne can be completely remissioned with 16-24 weeks of treatment. In patients with severe intolerance to the recommended dose, treatment can be continued for a long time with a lower dose. Capsules should be taken once or twice daily with meals.

In the majority of patients, acne can be completely cleared at the end of a single treatment period. In case of definite relapse, Isotretinoin treatment should be administered at the same daily dose and cumulative treatment dose as before. Since acne may develop for 8 weeks after discontinuation of treatment, treatment should not be resumed before the end of this period.

Use in thick-skinned noses: Usually 20mg Zoretanin capsules can be used for 5 months as 1 tablet morning and evening for the first month and then 1 capsule daily for the next 5 months. Use can be started 2 months before rhinoplasty operation. Do not apply these recommendations without consulting your doctor!

Special warnings and precautions for use

Liver failure:

Use in hepatic impairment is contraindicated.

Pediatric population:

Contraindicated in children under 12 years of age. In children older than 12 years, dose adjustment is not necessary.

Geriatric population:

Dose adjustment is not necessary.

Contraindications for products containing isotretinoin 20mg capsules

Isotretinoin capsules are contraindicated in the following cases:

Use of Isotretinoin capsules during pregnancy and lactation

Isotretinoin is contraindicated in women of childbearing potential, except when all conditions of the Contraception Program have been met.

In patients receiving concomitant treatment with tetracyclines 

- In patients with liver failure

Undesirable effects

Patients with extremely elevated blood lipid levels

- It is contraindicated in patients with hypersensitivity to isotretinoin or any of the other ingredients of this medicine. These products contain soybean oil, partially hydrogenated soybean oil and hydrogenated soybean oil. Therefore, capsules containing Isotretinoin are contraindicated in patients allergic to soy.

Special warnings and precautions for use

Teratogenic effects

Products containing isotretinoin capsules have been linked to a high incidence of severe and life-threatening birth defects

It is a potent human teratogen.

Isotretinoin capsules is strictly contraindicated in the following cases

- Pregnant women

- Conception unless all conditions of the Contraceptive Program are met

in women with potential_

Pregnancy Prevention Program This medicine is TERATOGENIC.

Isotretinoin is contraindicated in women of childbearing potential unless all conditions of the 

Contraception Program are met:

- Treatment of severe forms of acne (nodular or conglobate acne, or acne with risk of permanent scarring) and acne that has not responded to standard therapies in combination with systemic antibacterial and topical therapy.

Similar links >> To read my previous articles on thick-skinned nose published on this website, you can click on the link group >>

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
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