Kenalog for subtle nostril asymmetry three years post rhinoplasty? (Photos)

Question

I’ve had two rhinoplasties and am happy with my overall result. I do not want another surgery. My only concern is a small area of fullness/thickened tissue near the right tip-columella-soft triangle junction that makes my right nostril look slightly heavier and more downward-facing than the left from the front view. My surgeon suggested a very small Kenalog-10 injection. Does this look like the type of post-rhinoplasty fullness/scar tissue that may respond to Kenalog, or does it appear more structural and unlikely to improve without surgery? What would be the biggest risk of a small Kenalog injection in this area

Yasemin Aydinli, MD · Answer

Thank you &mdash; this is a thoughtful question, and it's reassuring that you're happy with your overall result. Localized fullness near the tip–columella–soft triangle junction three years out can be either soft-tissue scar/thickening or a structural issue (for example, slightly asymmetric cartilage or a graft edge). Kenalog (triamcinolone) works only on the soft-tissue, scar-type fullness &mdash; it thins thickened scar and reduces edema. If the heaviness is truly structural, Kenalog won't change it. From a photo I can give an impression, but distinguishing scar from structure really requires palpation: scar tends to feel diffusely firm and slightly mobile, whereas a structural edge feels discrete and fixed. Your surgeon, who knows what was done inside, is well placed to judge this.
If it is scar-type fullness, a very small, low-concentration, precisely placed injection can help. The main risks to understand are over-injection effects: skin and fat atrophy (a depression or contour dent), thinning that reveals underlying structure, hypopigmentation or visible telangiectasias, and &mdash; rarely but seriously &mdash; vascular events if injected too deeply or under pressure. The columella/soft-triangle area has delicate skin and named vessels, so conservative dosing, correct depth, and an experienced injector matter a great deal. Effects are also temporary and often need cautious repeat treatments spaced weeks apart.
Given that you specifically don't want more surgery, a trial of a tiny Kenalog injection by your surgeon is reasonable if they feel the tissue is scar-based &mdash; start low, reassess in 4–6 weeks, and avoid stacking doses. I'd suggest discussing exact concentration and volume with them, and if there's any doubt about whether it's structural, an in-person second opinion before injecting is wise.

Kenalog for subtle nostril asymmetry three years post rhinoplasty? (Photos)

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