Pros/cons of Steroid Injections After Rhinoplasty?

I'd heard doctors sometimes do steroid injections for swelling post rhinoplasty. Why do they not do it regularly? Are there drawbacks or bad side effects to the injections? Are they very expensive? Incidentally, I was prescribed oral steroids for five days post rhinoplasty. Would taking them again be advisable?

Doctor Answers (13)

Pros and Cons of Injectable Steroids in Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

This happens to be a somewhat controversial topic when it comes to rhinoplasty surgery healing. Below is a link to a page we have on our website that discusses this in a little more detail. I hope it provides you some good insight.


San Diego Facial Plastic Surgeon
4.5 out of 5 stars 20 reviews

Pros/cons of Steroid Injections After Rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 These are all very good questions and reflect the nuances of practices between Rhinoplasty Surgeons.  I have performed Rhinoplasty and Revision Rhinoplasty for over 25 years and have used post Rhinoplasty kenalog injections on numerous occasions when the post op course showed signs of increased subcutaneous scar tissue formation.

 The rationale behind using steroid (kenalog) injections after a Rhinoplasty are as follows.  Post Rhinoplasty swelling primarily occurs in and around the sura-tip (upper tip) area.  Persistent swelling is replaced by scar tissue which blunts the shaped nasal tip cartilages created during the Rhinoplasty.  An extreme example of this is called a "polly beak" deformity where the scar tissue acumulation actual deforms the nasal tip.

 The more thick and oily the skin the more prone to prolonged swelling the skin is after a Rhinoplasty.  We teach all our Rhinoplasty patients how to perform daily manual lymphatic drainage to the nose to reduce this swelling.  Oral steroids can be given as can intra-op IV steroids as a precautionary measure against scar formation, especially in Revision Rhinoplasty or in cases of previous scar tissue formation.  

 Kenalog decreases swelling and scar tissue but can also cause the normal tissue to atropy and indent.  For this reason, I dilute the kenalog 40 to kenalog 10 which decreases the likelihood of this happening.  IMHO, I only use kenalog when it is clearly indicated and typically only during the first 6 months post op when the majority of the swelling occurs.  IMVHO, if this scenario is followed there is very little downside to using Kenalog 10 when indicated during the first 6 months of the post Rhinoplasty process.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Post Rhinoplasty Steroid Injections

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

At times an inordinate amount of scar and/or edema (swelling) can build up in the nasal dorsum or tip. Such as after a resection of a dorsal hump deformity giving the appearance that the deformity has been inadequately resected. Steroids after rhinoplasty are used as a means to reduce the amount of scar tissue and/or swelling that has formed. While being helpful, it does have potential side effects. It may cause atrophy of the tissues resulting in a depression, or cause hypopigmentation (loss of color) or even thinning of the overlying skin. Make sure  you continue to follow up closely with your plastic surgeon as they will be best able to guide you through your post operative recovery. Best wishes.

Pedro M. Soler, Jr., MD
Tampa Plastic Surgeon
5.0 out of 5 stars 7 reviews

Steroid injections post Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 

The use of steroid injections post rhinoplasty is dependent on the patient and their needs. Personally I feel most swelling will dissipate in due time and it is best to allow this healing process to resolve. On some patients with thick skin and different ethnic backgrounds steroids may be helpful in resolving some tip swelling. While they are helpful to reduce scar tissue you want to make sure  that they are indicated for the problem being addressed. Steroids such as medrol dos pack may be given post surgery and are helpful in the healing process however would not typically be prescribed months after a procedure. Steroid injections are not expensive and if a patient of mine needed an injection it would be free of charge. I have an extremely busy rhinoplasty and septorhinoplasty practice and I can count on one hand the amount of steroid injections I have given in ten years. I hope this is helpful in opening up this discussion with your surgeon. Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 148 reviews

Pros and cons of steroid injections after rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Steroid injections to prevent or reduce scar tissue after a rhinoplasty procedure can be beneficial but also has the potential to create depressions that are difficult to correct. Therefore, it is prudent to follow up closely with your rhinoplasty surgeon and their judgement as it may or may not be necessary to have this treatment.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Pros and Cons of Steroid injections after rhinoplasty?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Swelling after rhinoplasty particularly in the nasal tip is normal and is a part of normal healing. There is little to stop the tip of your nose swelling as only a small volume of swelling can be visible in this area of the nose.
A combination of factors will help with reducing swelling one of which is the use of anti-inflammatory treatments to the tip of the nose, including steroids. Dr. De Silva advocates the use of such medicine in most patients to speed up the resolution of swelling and ensure faster recovery after surgery. Although the final results of rhinoplasty can be more than one year after surgery, the use of anti-inflammatories can shorten this period considerably. Patients with thicker skin which includes certain ethnicities and ethnic rhinoplasty, may benefit from more than one anti-inflammatory treatment. 
As with every medication there is always a small risk of side effects and anti-inflammatory medications are not suitable for every patient. Particularly in patients requiring more complex revision rhinoplasty, caution is required as steroids may rarely cause thinning of the skin resulting in a depression, or loss of colour (termed hypo-pigmentation.

Steroid injections for abnormal scar tissue or prolonged swelling after rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Steroid injections following rhinoplasty are indicated when there has been excessive scar tissue production deep to the skin - this manifests itself by the appearance of swelling. This is most commonly in the supratip (area just above the tip) or tip regions. Steroid injections typically take about 2-3 weeks to start to work. They should be used judiciously as when too much is injected or injections are performed to frequently, they can cause excessive thinning of the skin and contour irregularities, or loss of pigmentation that can take a long time to resolve. If further injections are required, they are typically done at least 6 weeks after the previous injection. It is better to be more conservative using steroid injections following rhinoplasty than be too aggressive.

Some surgeons prescribe oral corticosteroids for a few days following rhinoplasty in the belief that this may help reduce the early postoperative swelling resulting from surgery, however, the clinical studies about the effects of oral corticosteroids are equivocal. Prescription of oral corticosteroids is largely done based on the surgeon's preference. Personally, I do not prescribe these to my patients. For persistent or prolonged swelling after rhinoplasty, oral corticosteroids are likely of limited benefit.

Steroid Injections after Rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

   I have not found the need for steroid injections, but it is not unreasonable.  The risks would include skin pigmentation changes that can be very difficult to treat and depressions in the skin.  Kenneth Hughes, MD Los Angeles, CA

Steriods are used post rhinoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Steriods can decrease swelling and may alter how the ultimate scar forms after a rhinoplasty.  The advantages are it is non surgical. less costly than a surgical revision, convenient, and quick.  However, it  may be difficult to precisely estimate the exact result the steriod may have, if the steriod is injected too superficially it may cause changes to the skin.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Nasal steroid injections

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I am not a big fan of steroid injection of the nose after rhinoplasty. A recent review of the literature on this procedure does not support long term success in reducing swelling. It may cause fat atrophy and cause hypopigmentation, and spider veins as well.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.