How big of a problem is keloid scarring with rhinoplasty surgery?

Keloid formation is generally not a problem with rhinoplasty surgery. For some reason, incisions which are made in or close to the midline of the face don't seem to have a keloid problem. As always, discuss your concerns with your physician to ensure that all of your questions are answered.

Keloid scarring is not a problem with rhinoplasty surgery since all of the incisions are placed internally or inside the nose.    Patients with thick, olive, oily skin can develop edema just above the tip with some scar contracture underneath the tip.  These complications can be averted through cortisone injection treatment during the first three months after rhinoplasty. 

I have not seen a rhinoplasty-related keloid in my 27 years of practice.

With African American rhinoplasty, usually an external approach is used which involves a small inverted V incision under the columella (tip). The remainder of incisions are inside of the nose and have no danger of keloid formation.

It would be a good idea to inject your incision line with a tiny amount of Kenalog 10 after the wound heals.

Be well and good luck.
Dr. P

Your concerns are valid and it is important to discuss your history of poor scarring whenever you undergo any type of surgery. You should note however that different parts of the body will heal differently.

The simple answer is that keloids rarely develop in the central face and we here at Profiles have never seen a keloid develop after we have done rhinoplasty. A more in depth explanation begins with an explanation of scarring.

First, we need to help you in understanding the difference between a hypertrophic scar and a keloid. Clinically, hypertrophic scars are enlarged or thickened scars that stabilize or shrink with time. Keloids, however, initially develop as hypertrophic scars but later extend beyond the original injury area. They rarely regress on their own and have a propensity for recurrence after excision.

Keloids may affect virtually any surface on the body with the central chest, deltoid/shoulder region, and back having the highest frequency. And this has led some doctors to speculate that motion and tension play a large role in causing keloids to develop. While this may be true to some extent, the earlobes, which are one of the most frequent sites affected, are obviously subject to minimal motion or tension forces.

All this being said, while you should explore this issue with your doctor before surgery, you should feel some comfort in knowing that the nose is rarely a site for keloid development after rhinoplasty or nasal surgery. In fact, we did a literature review to check on your answer and were unable to find any papers that point to a case of a keloid after rhinoplasty.