Still taping 15 months post op with persistent swelling - what will help this? (Photos)

Question

I had 1st time rhinoplasty April of 2024. 15 months later, I am still having to tape my nose overnight to control the swelling. I have tried asking my surgeon but I don’t seem to be getting any clarity. For context, I’m an ER physician with a short attention span, and even I have felt he and his PA have been a bit dismissive. I am not sure what else to do at this point. i have thick skin and i have found that when I don’t tape it overnight my nose swells a decent amount. in the morning, (if i’ve slept well) my nose looks fantastic right after removing the tape. 8-12 hours later, it’s noticeably larger and FEELS swollen. The swelling doesn’t go away if I don’t tape it. I am concerned I’ve been taping it too long or too tightly, and potentially caused a problem. I have been on acutane for more than a year which has helped somewhat. I have also had 1 round of steroid injections at around 7-8 months post op. i’m not sure where to turn or what to do short of yelling at my surgeon in some dramatic fashion to get him to pay attention. not to mention i moved to Atlanta for my new job and the surgery was performed in NYC. Should I just stop taping all together? Should I get a new consult and see if revision rhinoplasty is needed? Would a series of CO2 laser treatments help get the skin to remain adhered? I could really use some thoughtful advice. I've included 3 examples of how swollen it gets vs shortly after tape removal.

Caner Kacmaz, MD · Answer

Unfortunately it takes longer for patients with thick skin to heal completely. In some cases even 18 months is normal for us to see the final outcome. In your case, due to the thickness of your skin, it is impossible to achieve a very small and defined nose. I hope that your surgeon explained this expected outcome during your pre operative consultation. I would recommend you to contact your surgeon again and ask him for options. It can be smaller with another round of steroid injections or a revision surgery. However, it won’t be possible to make it very narrow and small

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion my practice is dedicated to rhinoplasty surgery. There are several things that you can do to reduce the swelling.  First, is a low-salt diet. Second, you can try Retin-A to the nasal tip, however this may take 1 to 2 months to see some improvement. 3, you might want to try a steroid Dosepak and see if that helps. 4, another steroid injection to your nose with Kenalog 10 mixed with Kenalog 40 might help as well.  Lastly, you might want to try a device that I invented/develop called Noseperfect.  I hope this helps.  Best wishes to you.

Philip S. Schoenfeld, MD, FACS · Answer

The short answer is as follows.   I would suggest finding another surgeon willing to take on your case.  I suspect that they will suggest another round of steroid injections to your nose.  You do have very thick skin and I wonder if a course of Accutane would not also be of benefit to you.  You may want to see a dermatologist and see if that is an option.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a revision rhinoplasty or you could try more steroid injections. If undergoing a revision, the  surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. 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

Mats Hagstrom, MD (license on probation) · Answer

At 15 months, you no longer swollen.
The fluid in your tissue is normal interstitial fluid.
Taping may make it look better because you’re squeezing out excess fluid.
Taping it before your rhinoplasty may have made your nose look better as well.
There isn’t anything your surgeon can do to change the interstitial fluid in your nasal skin. 
Even if it seems more than you had prior to surgery.
You should think of your outcome as being your final result.
You can tape if you want to. The longer you keep taping the more it will reinforce the idea that the skin is swollen. If you press against the skin on any part of your body you can get a similar response. 
I’m sure your surgeon would like to make things better if they could, but there really isn’t anything to do. At least not that I can think of. 
A lot of plastic surgeon lean towards injecting steroids to appease the patient that they at least tried or did something.
Inappropriate use of corticosteroids is foolish.
While not common steroids can cause devastating permanent fat atrophy. 
We say rhinoplasty results are final at 12 months for a reason.
Even small amounts of swelling can change the appearance. Whether this is swelling or normal, interstitial fluid may be semantics at this point.
Some degree of swelling or interstitial fluid may be permanent.
Swelling would indicate, and there is some abnormal physiological process like blocked lymphatic drainage or ongoing inflammation.
I really don’t see a strong indication for any intervention.
Further treatments, like laser resurfacing is only going to create more inflammation and swelling as part of the healing process from that procedure.
Your surgeon and those responding all wish you the best and if there was something useful, I’m sure you would hear of it and it would be offered. 
Being a plastic surgeon requires putting up with patients who are not always content with surgical outcomes even if the procedures were done correctly. 
Best,
Mats Hagstrom MD

Still taping 15 months post op with persistent swelling - what will help this? (Photos)

Answers (5)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Swelling 15 months after rhinoplasty

Answer: Swelling 15 months after rhinoplasty

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Still taping 15 months post op with persistent swelling - what will help this? (Photos)

Answers (5)

Answer: Rhinoplasty

Answer: Rhinoplasty

Answer: Swelling 15 months after rhinoplasty

Answer: Swelling 15 months after rhinoplasty

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.