Do I Need A Revision Rhinoplasty or Steroid Injections?

Q: Dr. Eppley, I may be interested in a revision rhinoplasty. I had excessive swelling after nose tip rhinoplasty; nose tip looks great, but my formerly thin nose is much wider and uglier above the tip; and very damaging to me psychologically. I have had two Kenalog (diluted) injections within 15 to 18 months post-op, with limited results. I am completely aware of the risks of revision rhinoplasty. Please advise on whether further kenalog might help, or would recommend a revision.

A: At over one year after a rhinoplasty, there is not going to be much of a change from any form of steriod injections. Steroids or even 5FU work by either preventing or helping to break down early scar tissue formation. This can occur when the collagen bonds are relatively newly formed. But when the scar is mature, as it would be at one year after the initial rhinoplasty, the collagen bonds are too stable to be pharmacologically broken down. Whether a revision rhinoplasty will help thin out a nose above the tip in the middle vault area or higher, however, is suspect. It is not like in the tip where scar tissue can be easily removed and additional reshaping of the cartilages can be done. There is also the distinct possibility that with a more narrow tip, the rest of the nose above it may merely look bigger by comparison. That may not be a major component to the existing nasal issue, but it may be part of it.

Dr. Barry Eppley