Comparison of Postoperative Edema Between Sub-SMAS and Subperichondrial Dissection Planes in Rhinoplasty Using Ultrasonographic Skin Thickness Measurements.

[BACKGROUND] This study aimed to objectively compare postoperative edema between subperichondrial and sub-SMAS dissection planes by assessing skin thickness via ultrasonography.

[METHODS] Forty-four patients undergoing rhinoplasty were randomly assigned to two groups based on the dissection plane: Group I (subperichondrial) and Group II (sub-SMAS). Skin thickness was measured at the nasal tip, supratip, and dorsum preoperatively and at postoperative week 1 and month 1.

[RESULTS] Mean dissection time was 13.3 ± 1.4 minutes in Group I and 12.5 ± 1.4 minutes in Group II (p = 0.05). Baseline skin thickness was similar between groups at all measurement points. At postoperative week 1, Group I showed significantly lower thickness values at the tip (p = 0.024) and supratip (p = 0.027) compared to Group II; no significant difference was observed at the dorsum (p = 0.13). By month 1, skin thickness differences between groups were no longer significant at any measurement point. The percentage increase in thickness was significantly higher in Group II than in Group I at the tip (p < 0.001) and supratip (p = 0.027). No significant differences in percentage change were found at any site by the first-month evaluation.

[CONCLUSION] Subperichondrial dissection is associated with less edema at the nasal tip and supratip in the early postoperative period. However, these differences become clinically insignificant by the end of the first month. Although subperichondrial dissection requires a slightly longer operative time, this difference is clinically negligible and should not be considered a limitation.

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