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Intermittent nasal tip and nostrils fullness years after revision rhino - is Kenalog an option?

Exuberant801907Dec 23, 2025
I am about 4 years post revision rhinoplasty. Structurally my nose appears stable, and I do not have a constant deformity. However, I notice intermittent changes in my nasal tip and alar appearance — some days the tip looks sharper and more refined, with the nostrils appearing narrower, while on other days the tip looks rounder and fuller and the nostrils appear wider. These changes fluctuate rather than remain fixed. About 3 years post-rhinoplasty, I completed an 8-month course of Accutane. During that time, my nose — especially the tip — looked more refined and narrow than I had ever seen before. Since stopping Accutane, I still have days where my nose looks close to that refined appearance, but other days where it looks fuller again. I do not have a persistent polly beak or a scar lump that looks the same all the time. My question is regarding Kenalog injections to the nasal tip: • In cases where tip fullness is intermittent rather than constant, is Kenalog ever appropriate? • How do surgeons distinguish true fibrotic scar tissue from vascular, sebaceous, or inflammatory soft-tissue changes years after rhinoplasty? • Does a strong response to Accutane suggest this is a soft-tissue issue rather than scar tissue, and therefore a contraindication to Kenalog?

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Dr. Richard G. Reish, MD, FACS
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Dr. Richard G. Reish, MD, FACS
Board Certified Plastic Surgeon
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Answered on Dec 25, 2025
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