Amorphous Nose at 4 Months Post-op, Dr Doesn't Believe is Using Steroid Injections, Other Options for Swelling? (photo)

Hi, I had a rhino about 4 months ago and I have significant swelling in my supratip and tip. My PS is not concerned and told me he doesn't believe in steroid injections and also suggested more surgery! He is a top rated doctor in the boston area though so I want to trust him. I know I have to give it time to heal, but at the same time, is there is something I can do to help things along? I've included my before and projected pics as well. Will my nose look like the projected photo?

Doctor Answers 8

Amorphous Nose at 4 Months

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Based on your photos it is not likely that you will get the projected image but you will continue to see changes in the nose up to and often beyond 1 year.  In general it is a good idea to wait about one year before seeking a revision.  There are a number of good reasons for this, which your surgeon can discuss with you.

Amorphous Nose 4 Months after Rhinoplasty

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Although I will occasionally use steroid injections post rhinoplasty, I agree with your surgeon that it probably will not help you. All you can do at this time is be patient and wait to see if the fullness decreases as healing progresses. If you and your surgeon are not satisfied a revision can be done.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

You may benefit from a second opinion about your Rhinoplasty Surgery.

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I read your concerns and reviewed your photos which are limited:

You appear to have irregularities at the top of your nasal bridge, and fullness above your tip. I'm not sure if the fullness above your tip is swelling or under-resection of cartilage. In that regard, you may benefit from a second opinion from a reputable rhinoplasty surgeon to determine what might be best for you.

Hope this helps you.

Dr. Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 430 reviews

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4 months post rhinoplasty

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You do appear to have  fullness along the  nasal bridge and somewhat amrphous overprojected nasal tip.  You may benefit from steroid injections which can reduce swelling of the supratip  but ultimately you may need to have a revision procedure to achieve your goals.  It appears as if you have thicker skin  and have still have excess cartilage along the dorsum.  Your nasal bone has been lowered more than the cartilagenous dorsum creating a  pollybeak deformity. You should let  one year pass before you can  judge the result.  Speak to your surgeon  and consider getting  a second opinion before proceeding with revision surgery.  

Amorphous nose at 4 months postop; to inject or not to inject with steroids

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By four months, the was majority of your swelling should have come down and therefore steroids are unlikely to have a great effect. I agree with one of the previous physicians in that you likely had under-resection of your nose. While not a classic pollybeak deformity, it is a problem that all rhinoplasty surgeons have faced. It's very common to focus on the highest part of the hump and undertreat the middle third of the nose.

I can't specifically speak for your physician, but the fact that he is suggesting more surgery sounds like he feels the same way. From the rest of your photos it appears that the rest of the nose looks fine.

I hope that helps and good luck.

Michael Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 40 reviews

Amorphous Nose at 4 Months Post-op, Dr Doesn't Believe is Using Steroid Injections, Other Options for Swelling?

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I don't believe this is swelling. At 4 months most of the swelling should have dissipated. It looks like you may have an over-projected tip and a slight pollybeak or under-resected dorsum. This may be contributing the amorphous look. See link below for further explanation.

Steroid injections after rhinoplasty

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It appears from you r photos that your surgeon did a great job, and that you do have a bit of swelling in the supra tip. I agree with his course of treatment, I am also not a fan of steroid injections, as they may cause problems. I reserve them for very specific cases, and yours, in my opinion is not one of them. Be patient and you will be happy in the long run, rather than risking creating a problem.

Amorphous Nose at 4 Months Post-op, Dr Doesn't Believe is Using Steroid Injections, Other Options for Swelling?

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 The only options to manage post Rhinoplasty swelling and scar tissue formation, IMHO are kenalog injections (when and if required) and precise nasal lymphatic drainage that's performed daily by the patient beginnning at 1 month post-op. 

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.