Scar tissue after revision rhinoplasty - what can be done to fix this? (photos)

Question

I am 4 years post-op - my second rhinoplasty and I am super unhappy with the appearance of my nose. I have scar tissue and have been getting injections from my plastic surgeon but they don't seem to be helping and possibly making the scar worse. Is that possible? Is there any minimal procedures that can be done to fix the scar? The first picture is of my nose before my second rhinoplasty. I'm also wondering if I would benefit from a third rhinoplasty. Thanks!

Steven J. Pearlman, MD, FACS · Answer

Scar tissue is the go to reason when there is a bump following rhinoplasty. Sometimes it is not scar tissue. If a few injections of steroid did not help, it may angulation or an irregularity in the remaining cartilage. Two surgeries can weaken cartilage so it bends excessively. Of course, this cannot be determined without a personal exam and sometimes even surgical exploration. Supporting or replacing the crooked piece of cartilage may be necessary. You should see a specialist in revision rhinoplasty for an opinion.

Stephen Kleid, MBBS, FRACS · Answer

The bump on the left side of your nasal dome might not be scar, and that is why the steroid injections are not helping, in fact making it worse.I suspect that the bump is cartilage, and steroid injections thin the overlying dermis (the fibrous deep layer of the skin), making he bump more apparent .The problem for your next surgeon (I don't think it should be the surgeon who did the first two, even though he should have done the revisions of his own cases at no fee to you), is that this will be your 3rd operation, and each one becomes more difficult, less predictable, and re-shaping that cartilage runs the risk of losing nasal tip support, causing nasal obstruction, valving, or perhaps a "pinched-looking" nose.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Daniel Barrett, MD · Answer

Dear Tough726050,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Veysel Sarraf, MD - Account Suspended · Answer

hiAccording to the photoes that i saw. There is a problem of the left alar cartilage. So i recommend to reshape the tip by tipplasty surgery.
Get well soon

Scar tissue after revision rhinoplasty - what can be done to fix this? (photos)

Answers (5)