Video 4.13: Perichondrio-SMASectomy for Thick-Skinned Patients

What this video shows

Thick-skinned patients are traditionally managed with SMAS debulking and repeated postoperative steroid injections, an approach the book finds insufficient and not without risk. Video 4.13 shows the alternative developed by Prof. Dr. Suleyman Tas: removal of the SMAS tissue together with the perichondrium, the perichondrio-SMASectomy, which thins the soft tissue hump of the supratip and can reduce the need for steroids to zero.

The book also describes perichondriumectomy alone as a safer option in terms of visibility when the patient needs redraping and has moderately thick skin, and it explains where and how the soft tissue hump forms.

Key points

• Indication: thick skin with a soft tissue hump at the supratip.

• SMAS is removed together with the perichondrium.

• Steroid injections after surgery can be avoided.

For patients with thick skin: this is the step that makes tip definition possible without months of cortisone injections after surgery.

In the book: Chapter 4 – Nasal Tip Surgery, section 4.3.10 Perichondrio-SMASectomy – 4.3.10.2 Surgical Technique, pp. 100–104 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.