Last year, a series of TikTok videos showed us how the acne drug isotretinoin, or Accutane, resulted in what users called the “Accutane Nose Job.” Countless creators have documented their smaller, narrower noses after just a few months of using the drug. While it may seem like an exciting TikTok discovery, Campbell, CA plastic surgeon R. Laurence Berkowitz, MD says facial surgeons have studied the drug’s reshaping abilities and are using it in conjunction with rhinoplasty now.
The Accutane “Nose Job”
So, how does the “Accutane Nose Job” work? “It’s important to note that using Accutane outside of its prescribed use, usually for acne, is not recommended and is extremely dangerous,” explains Smithtown, New York facial plastic surgeon James C. Marotta, MD. “It works by inhibiting the production of sebum, or oiliness, in the skin and reducing the size of the sebaceous glands. In theory, someone with thick skin will see an improvement, but it’s by no means a ‘nose-job’.”
Current president of The Rhinoplasty Society, Palo Alto, CA, facial plastic surgeon Sam P. Most, MD says many users may notice a smaller nasal tip after use. “The skin of the tip of the nose and the Ala, or nostrils, has many sebaceous glands,” he says. “So it can cause the skin to shrink and thin, which can lead to a smaller limb.”
“This is not new news,” adds Spokane, dermatologist Wm. Philip Werschler, MD. “The ‘Accutane Nose Job’ idea or that isotretinoin works that way is actually old. It only works for people with hyperplasia of the sebaceous glands or large, overgrown oil glands on the nose, chin and forehead.’ Dr. Werschler adds that it’s been a Hollywood secret for years. “This started in the film industry several decades ago,” he says. “Studio dermatologists prescribed low doses to young actors on set to reduce oil production to ensure on-camera makeup looks fresher and longer.”
Its role in rhinoplasty
Dr. Berkowitz notes that surgeons have noted the “Accutane Nose Job” for some time and are even treating isotretinoin as an adjunct to rhinoplasty. “As a rhinoplasty surgeon, we are limited by the thickness of the skin,” he explains. “When the skin is too thick, you can’t really see it. You can do whatever you want with cartilage and bone, but you’ll barely notice. If the skin is too thin, you end up with all kinds of unusual distortions and things that don’t look good. So you want the skin to be just the right thickness.”
Dr. Berkowitz adds that treatment with isotretinoin a few weeks after surgery has helped improve outcomes for the right candidates. “I don’t use it until the nose is fully healed about four to six weeks after rhinoplasty, so it won’t interfere with wound healing,” she explains. In a study published in 2021 in Aesthetic Plastic Surgery journal, patients who received isotretinoin said they were more satisfied with the results of the procedure and experienced fewer skin problems.
Only suitable for some
Facial plastic surgeon David W. Kim, MD in San Francisco, CA, explains that the “Accutane Nose Job” is largely a myth, and that taking Accutane alone won’t change the structure of your nose because it doesn’t target or heals the bones or cartilage of joints. “The structural anatomy of the nose does not change, however the cap becomes thinner. It would be like a nose swapping a puffer jacket for a t-shirt. While longevity varies from person to person, most will have long-lasting results.”
Dr. Most agrees and says don’t start Accutane if you don’t really need it. “At least one study has shown that these effects are temporary,” he adds. “It certainly seems that the risks — Accutane is quite toxic and should be used with caution in women of childbearing age — may outweigh the benefits in most cases. Even so, some patients with extremely oily and thick skin may benefit from use.”
