What causes increased fibrosis and internal scarring after rhinoplasty?

Question

I know that every rhinoplasty causes internal scarring and fibrosis to some degree normaly it does not affect the shape of the nose. But in some patients it is so pronounced that it changes the whole nose shape negatively (For example: bumps, droppy nose, bigger looking nose..) often times revision is recommended in these cases but how can it be guaranteed that it will not happen again?

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. When the nose heals after rhinoplasty, the body will produce healing tissue that will drape over the bone and cartilage in the nose. The amount of scar tissue that develops is unpredictable and will vary from patient to patient. But in general, the thicker the nasal skin, the more scar tissue will form. Over time and as tissue remodeling continues, the tissue should thin out and reveal more nasal definition. However, the skin’s ability to contract is finite, and if there was too much nasal reduction, the scar may not thin out. This typically happens in the lower third of the nose.

The best way to prevent this is to be strategic in the surgical approach, particularly a more conservative one. Your surgeon should not reduce the nose beyond the skin’s ability to contract. To learn more, I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon, particularly one with a strong rhinoplasty portfolio. Such experts will have the skill and training to perform the most advanced surgical techniques. Your surgeon can assess your nose, listen to your concerns and goals, determine the best approach, and ensure the best possible outcome.

Alan Gonzalez, MD, FACS · Answer

Hello @mimii90, thank you for your question. There are several factors that play a role in the healing process. Many of them are intrinsic, and will not be visible until after surgery has been completed. For more information and recommendations, consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Zoran Potparic, MD · Answer

Scarring after surgery may be unpredictable to a certain degree; it is very hard to predict which patient would have that problem unless there is history of similar event in the past. However, this condition is not frequently observed in patient undergoing  primary (first time) rhinoplasty. Hope this may help.

Ronald J. Edelson, MD · Answer

An experienced rhinoplasty surgeon knows how to avoid such problems. Something’s that are blamed on scarring are legitimate such as a thick tip. Taping the nose after rhinoplasty minimizes the scar tissue by keeping the swelling down.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Increased fibrosis may occur after rhinoplasty if there is postoperative bleeding, postoperative infection, circulatory embarrassment, or hereditary scar forming tendency. 
These complications are quite unusual but one can never "guarantee" a surgical result with living tissue.
Best wishes...

What causes increased fibrosis and internal scarring after rhinoplasty?

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