Background <p>Rhinoplasty enhances nasal aesthetics and function but faces challenges in thick-skinned patients due to limited contour definition and higher risks of scarring and complications. Isotretinoin shows promise in reducing skin thickness and improving healing, but its side effects necessitate careful monitoring.</p> Aim <p>To consolidate existing evidence on isotretinoin efficacy, safety, and impact on satisfaction to guide decision-making for this patient population.</p> Methods <p>We retrieved relevant articles up to December 2024 from PubMed, Scopus, Web of Science, and Cochrane Library. Data were extracted from eligible studies by two independent reviewers, including baseline information, type of surgery, isotretinoin regimen, study outcomes, and complications.</p> Results <p>Higher satisfaction was found with isotretinoin use post-rhinoplasty at three and six months post-op; however, satisfaction often declined by 12 months. Isotretinoin improved cosmetic results, reducing skin thickness and enhancing nasal definition for up to six months. Nonetheless, differences in outcomes between intervention and control groups diminished by one year. Complications like dryness were common but manageable, while systemic side effects were rare.</p> Conclusion <p>Isotretinoin offers short-term benefits after rhinoplasty for thick-skinned patients, with diminishing effects by one year. Similar efficacy was noted for both oral and topical formulations, favoring topical formulations for their milder side effects.</p> Level of Evidence I <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>