Excess scar tissue and over projection - should I pursue a revision 5 years post op? (Photos)

Question

I had a primary rhinoplasty and septoplasty in 2021. It looked great at year one, but I later developed dents and bumps from suspected scar tissue. In 2022, I received three rounds of Kenalog injections. I also received filler around that time (3 years ago) to smooth out the remaining irregularities.Ever since, my nose has felt huge, looks extremely over-projected, and still swells severely in the heat. I suspect I have a massive buildup of scar tissue in the tip, compounded by the filler.I am highly conflicted about my next steps and would appreciate expert opinions: Could the current bulk and over-projection be caused by the 3-year-old filler still holding onto fluid and swelling? Should my first step be to dissolve it? Because I already have a history of aggressive scar tissue (requiring Kenalog), is a revision rhinoplasty too risky? Will a second surgery just trigger even more scar tissue? Given the over-projection and tissue thickness, is a surgical revision worth the risk, or am I safer leaving it completely alone?

Steven M. Denenberg, MD · Answer

If the nose looks too projecting and too long (longdroopy), then a revision would almost certainly be needed to reduce the overall size of the nose. It's just very unlikely that the filler is doing anything at all at this point (as long as it was a filler that goes away on its own). It's weird that the nose looked fine at one year but *later* did something to tempt the surgeon to put in Kenalog.

In general old scar can be carved out in a revision procedure, especially if enough cartilage was left behind to help support your nose in the first procedure, and the fact that the nose is still long and strong in its projection indicates that there probably is plenty of cartilage remaining.

I don't know that I'd have *anything* injected into the nose now. I'd re-confirm the type of filler, and if it's a filler that usually is gone in 6-18 months, I'd just assume it's not a factor, because you don't want anything injected that might cause some reaction and further confuse the picture. Probably you need to visit someone who could perform a revision so the revision surgeon can *feel* the nose and try to determine what is cartilage, what is scar, and give you a good idea of what is possible.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Umang Mehta, MD · Answer

thanks for the question. i’d recommend having the filler dissolved followed by a consultation with a surgeon who specializes in revision rhinoplasty. the scar tissue can be directly removed during surgery and your skin can be thinned. your tip can be refined with advanced tip suture techniques. after surgery, you may need a combination of low dose accutane and steroid injections to further improve your results as the swelling goes down. overall, it looks like you are a very good candidate for surgery, but i’d recommend seeing an expert, as you want to make sure your next surgery is your last one!

best,
dr. mehta

best,
dr. mehta

Excess scar tissue and over projection - should I pursue a revision 5 years post op? (Photos)

Answers (3)

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