How Many Kenalog Injections Are Ideal After Rhinoplasty?

Question

I had my first rhinoplasty last year and the doctor gave me a kenalog injection a week post-op and another 5 months later, but scar tissue started to form 2-3 months post-op. I had a revision last week to have scar tissue removed and my doctor just gave me an injection. Should I ask for another injection? I want to do anything I can to prevent excess scar tissue from forming again. How many injections do doctors that use kenalog usually give their patients after surgery and when?

Sarmela Sunder, MD · Answer

Hi,

	There is no standard number of Kenalog injections that one should have following surgery. It really depends on how your body responds to the injections. Most surgeons use as many injections as is necessary to achieve an adequate result or until there is no further progress.  This could be just one injection or several injections. Most surgeons space the injections over the course of several weeks (4-6 weeks) in between injections. Good luck with your healing.

	Dr.Sunder

Jamil Ahmad, MD · Answer

Steroid injections after rhinoplasty are not required in the majority of cases. Swelling is a normal phenomenon following rhinoplasty and resolves over time. Steroid injections following rhinoplasty are indicated when there has been excessive scar tissue production deep to the skin - this manifests itself by the appearance of swelling. This is most commonly in the supratip (area just above the tip) or tip regions. Steroid injections typically take about 2-3 weeks to start to work. They should be used judiciously as when too much is injected or injections are performed to frequently, they can cause excessive thinning of the skin and contour irregularities, or loss of pigmentation that can take a long time to resolve. If further injections are required, they are typically done at least 6 weeks after the previous injection. Steroid injections can be quite unpredictable-sometimes they can appear to have minimal or no effect and in other cases they can lead to the dramatic side-effects that I mentioned previously. Ideally, the fewer injections that are required, the better. It is better to be more conservative using steroid injections following rhinoplasty than be too aggressive.

Michael A. Persky, MD · Answer

Hi Looking,

	The ideal number of Kenalog injections after rhinoplasty is 0.  Kenalog can be injected after rhinoplasty in hopes of decreasing swelling and the formation of scar tissue.  There is no ideal time or number of injections.  The timing and frequency of Kenalog injections should be determined by your surgeon, assuming that your surgeon is skilled and experienced in rhinoplasty.  I hope that your nose heals well.  Good luck and be well.

	Dr. P

Etai Funk, MD · Answer

Kenalog injection after rhinoplasty or nose surgery should be reserved for an area of the nose, typically just above the tip, that remains a little full due to scar tissue. The steroid will help slow the scar tissue formation and provide a smoother result. Typically, steroid is not needed unless you have thick nasal skin, have had previous surgery, or are not healing according to plan. I rarely inject steroid but typically wait 1 month after surgery before the first injection. Then, injections are reserved for every 6 weeks if necessary. Overinjection can lead to dermal atrophy or thinning of the skin. Good luck.

Julian De Silva, MD · Answer

Swelling
after rhinoplasty particularly in the nasal tip is normal and is a part of
normal healing. There is little to stop the tip of your nose swelling as only a
small volume of swelling can be visible in this area of the nose.

A
combination of factors will help with reducing swelling. Firstly, sleeping with
your head slightly elevated above the rest of your body. Secondly, the use of
taping compression of your nose soon after surgery. Thirdly, the use of
anti-inflammatory treatments to the tip of the nose, including steroids. Dr. De
Silva advocates the use of such medicine in most patients to speed up the
resolution of swelling and ensure faster recovery after surgery. Although the
final results of rhinoplasty can be more than one year after surgery, the use
of anti-inflammatories can shorten this period considerably. Patients with
thicker skin which includes certain ethnicities and ethnic rhinoplasty, may
benefit from more than one anti-inflammatory treatment. As with every medication there is always a small risk of
side effects and anti-inflammatory medications are not suitable for every
patient. There is no optimal number of treatments, as the number of steroid injections should be tailored to your individual needs some patients may need no treatments at all, some may require a course of steroid treatments to give the best final result.

Richard Dale Reynolds, MD · Answer

The ideal number is zero but if it is necessary, I never give more than 2 injections, 6 weeks apart.

Michael L. Schwartz, MD · Answer

There is no hard rule to how many and how often. I also will inject after the first week in patients who I think have thick skin and are at high risk for scar tissue to form and blunt the result. I'll repeat it at 3-4 weeks if I still think that there is swelling that will respond to it. In ocasional patients I may repeat it again at 3 months but this is not routine for me. Other surgeons have their own routine based on their experience. Some may never do it. Regardless the decision has to be based on what your surgeon thinks is best in your case, not how often others do it.

Mohsen Tavoussi, MD, DO · Answer

It is best to have Kenalog injection early post operative period when scar is forming to prevent its formation. Your surgeon is the best person to decide when is the right time to have this done.

David A. Bray, Sr., MD · Answer

Unfortunately, steroid injections do not always work. When they seem to improve scar formation,I inject every two weeks until no further improvement  is seen.

Gregory Branham, MD · Answer

I agree with Dr. Funk. Kenalog should be used after rhinoplasty only if needed. In cases where it is needed, I will usually inject after a month to allow acute swelling and edema to improve prior to injection. There are patients who tend to develop thickened scar tissue after rhinoplasty and it sounds like you are, unfortunately, one of them. Kenalog is particularly useful in reducing and thinning this immature scar tissue if injected before the scar tissue matures and becomes more organized and resistant to kenalog. It does not reduce bony deformities or major cartilage deformities and should not be used for those situations.

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