It's been a little over a year and a half since my Rhinoplasty, and I am still experiencing stiffness and swelling on the tip of my nose. Also, my tip is crooked and not straight (it angles to the right). I imagine it's swelling and possibly scar tissue, but I'm not sure. How can I get rid of this? Exercises to the nose? A Kenalog injection? If an injection, how much? I'm using Arnica gel on it 3x a day. Thank you for your time.
Correcting Nose Problems 1 Year After Rhinoplasty
Doctor Answers 6
Correcting Nose Problems a Year After Rhinoplasty
Rhinoplasty revision rates vary from 3 to 10% depending on the surgeon and the type of noses that they operate upon. After 1 1/2 year, the deformities that you describe will not respond to steroid injections. Filler injections may balance you nose temporarily, but your best course is to return to your nasal surgeon or a different surgeon for a revision rhinoplasty.
You are fortunate to be in Chicago (not because of the Cubs success in getting to a World Series) as their are a number of excellent revision rhinoplasty specialists including Dean Toriumi MD, Regan Thomas MD, and Steven Dayan MD.
Good luck and be well. Go Bears!
Post operative Tip problems
This far after your surgery, swelling that can be attributed to the procedure should no longer be an issue. There are numerous techniques in rhinoplasty that can produce tip stiffness. Although grafts can produce this phenomenon alone, they usually do soften over time and stiffness resolves. Although unlikely, a low grade infection involving a suture or an implant may result in tip swelling and stiffness. However, you would have symptoms if this was the case. If septal bone, non cartilage implants, or rib cartilage were used to reformat your tip, then this may explain the stiffness. The other possibility is that the tip cartilages were sewn onto the caudal septum (the bottom most part). This technique is called a "tongue in groove" technique. This is done to try and control tip projection and position but can result in an immobile and stiff tip, as you describe.
Injections or creams at this point are probably not going to help. Your best bet is to re-consult the original surgeon to see what can be done. That person has the best knowledge about your current nasal anatomy and will give the most educated advice about your options.
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Not much can be done without revision surgery.
After a year and a half any process related to healing should be long finished. Your asymmetries are probably surgical in origin and can be related to technique and/or scar. This can be seen by comparing before and after pictures. Tip stiffness can also be caused by the surgical changes. I would recommend revisiting with your original surgeon and get his/her opinion on what is going on. If you do not understand/agree with their answer visit a specialist in revision rhinoplasty to get another opinion and bring all your records to help them understand what the first surgeon did. Understand that correcting a nasal tip can be very difficult.
Probably this will require a minor office surgery.
Usually by one year the swelling regarding tip deviation is gone. This will require a minor office procedure. Return to the original surgeon and he will evaluate your status with the knowledge of what he did in the primary surgery and what will be required to fix it. In more than thirty years of doing noses I have not found taping or injections of any benefit for deviation at one year after surgery.
Stiffness may last
It really depends upon what was done during your rhinoplasty. Sometimes, certain grafts are placed in the tip and as a strur between your nasal cartilages to m ake the tip project better. Sometimes this forces the tip to be very rigid. It would be difficult to assess withour seeing you or having a copy of your operative report. If a graft wasn't used to keep the tip rigid, then it is most likely due to scar tissue in the tip from surgery, and ususally it gets softer over time.