Kenalog injections to refine nose tip in thick skinned patient? (rhinoplasty 3 years ago)

If too much cartilage was removed, then your tip will look amorphous and round. Kenalog can help with the internal scar, but your main issue is the need to build a strong internal support structure of cartilage to get the tip back to a nice shape. I would most likely use some kenalog in conjunction with a planned revision rhinoplasty.

The best way to create nasal tip refinement during Asian rhinoplasty is to create greater structural support for the tip of your nose, rather than to simply attempt to thin out the skin.  Kenalog injections may help to a certain degree, but only if you have appropriate tip cartilage support and strength.   

Kenalog injections after 3 years? I have not used these this long after rhinoplasty since I do not think they will change anything and could make things worse.

There are many maneuvers which can improve the nasal tip surgically. You cannot expect miracles from a few kenalog injections. You would benefit from an in person consultation from a board certified
facial plastic surgeon with expertise in Asian rhinoplasty.

Kenalog does reduce scar tissue and can thin normal tissue.  Its important to not use too much as you can cause normal tissue to atrophy and sink in.  Kenalog comes in 40mg/cc or 10 mg/cc.  Its safer to go slowly by using the 10 mg/cc and do multiple injections rather than a big 40mg/cc shot.  Usually I use 0.5 cc of Kenalog 10 every two months to help shrink the nasal tip. 

We usually use kenalog injections within the first year after rhinoplasty to decrease scar tissue formation and swelling as you researched. While kenalog has been known to atrophy fat in the skin if injected in the subcutaneous layer, I would tread VERY carefully. To think that you can shrink skin with kenalog is pretty risky in my mind. 

It seems that you need a revision in which the nasal tip's architectural integrity must be preserved. It is almost always ideal to use grafts derived from the septum (wall between the nostrils), ear, or rib because they do not cause implant-related problems such as protrusion, visibility, etc.  The rate of short- and long-term complication is also notably low with the use of natural tissue. Kenalog injection, meanwhile, is a temporary solution.  Oftentimes, it is used to control persistent swelling, a common concern of ethnic rhinoplasty patients whose skin is generally thicker compared with Caucasians'.To determine what really needs to be done, go to a board certified plastic surgeon (preferably certified by the American Board of Plastic Surgery) who mainly performs revision rhinoplasty.Good luck and best wishes. 

Hi Jaydee91,Though a personal evaluation will be needed to give a definite recommendation, in general, Kenalog Injection can really thin out subcutaneous tissue as well as the skin, however, it may not give you a precise definition as much as surgery will. It may decrease the volume (size) of the tip slightly, however, if you do not have good cartilage support on the tip (as you mentioned), the result may be further than expected, and may even cause asymmetry. Kenalog injection is also not permanent and may even induce development of visible, red, broken vein on the injection site.