How can I reduce internal scar tissue after a rhinoplasty surgery?

Rhinoplasty surgery evokes a lot of scar because it is a small anatomical region that has a lot of surgical trauma for a given area. The swelling takes a long time to subside due to lymphatic drainage blocks. One of the ways to reduce swelling is small steroid injection into the tip. I sometimes place steroid injection in the tip during the operation.
Other wars to reduce swelling in the immediate after care is constant taping and LED light therapy.

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

Dear Michelle,There are a couple of things you can doThe first is to add 5-FU to your steroid injections which will definitely help thin the skin.  I frequently combine it with kenalog 40 (the stronger steroid) and it helps thin the skin permanentlyThe second, and more aggressive treatment, is using Accutane.  It is an acne medication and there have been some studies looking at how Accutane can thin the skinBest,Dr. Nima
Member, American Academy of Facial Plastic and Reconstructive Surgery
Board Certified Facial Plastic Surgeon
Board Certified in Head and Neck Surgery

Without photos and the benefit of a detailed examination- it's difficult to give the best answer. After several in person opinions, you'll have to make a decision as to if or not additional surgery can be possibly beneficial.

Hello,With any surgical procedure there is risk of scarring.  Some patients will have a more robust response than others.  Although it is sometimes tempting to undergo a revision, I would caution you about reoperating and making sure that you give yourself enough time to heal.  I'm unclear as to the timing of your procedures, but reoperating before you have fully healed can sometimes just exacerbate inflammation and scarring, reducing the chance of a successful surgery.  The post operative recovery can be extended with each revision surgery, so although it is not always easy, try to be patient.   There are other medications that may be used to help reduce scar tissue if your physician finds it appropriate.

Kenalog is my first line treatment for thick scar tissue combined with massage. Since you have had many procedures, you will have a greater amount of scar tissue than a primary rhinoplasty patient. Several other surgeons have mentioned accutane as a treatment for your thick oily skin. Accutane is an oral (systemic) treatment with systemic side effects that you may not be willing to accept if you do not have severe facial acne outbreaks. Consider treating your nose with a topical retinoid like 0.1% tretinoin as an alternative. It should also decrease your sebaceous gland production, reduce pore size, and help the appearance of your nose and facial skin. Discuss with your surgeon the risks and benefits of these treatments to decide which is best for you.

There are a few things that can be done to reduce scar tissue following a revision rhinoplasty.  Scar tissue can be softened with injection of a steroid called kenalog.  There is a 10% (lower) or 40% (higher) dose, depending on the amount of scar tissue present and your body's response.  5-FU can also be added to the injection for additional effect.  These injections can be performed up to 1 month apart until the scar tissue softens to a satisfactory level.  Ultimately, if the scar tissue does not soften after a year, surgical removal of scar tissue can also be performed in a subsequent minor revision operation.  Having multiple previous rhinoplasties puts you more at risk of greater scar tissue formation.  For thick, oily skin that conceals tip definition, you could be placed on Accutane.  Best of luck in your recovery!
Ziyad Hammoudeh, MD

Sorry to hear about everything you have been through. Unfortunately this is a tough problem without an easy solution. There is no data regarding prophylactic steroids and reducing scarring in rhinoplasty. I do treat scarring with injections of kenalog rather aggressively in patients that are forming scar tissue. As in every surgery, the risks of proceeding with surgery should be weighed with the benefits to determine whether another surgery is the right choice for you. 

Revision Rhinoplasty is more difficult than a Primary Rhinoplasty, especially after 3 rhinoplasty procedures.  A thorough internal and external examination of the nose will be required to determine the thickness of the skin and the extensive scar tissue formation.  Always best to have copies of the operative reports to know what has occurred on 3 previous procedures.  Steroid shots mixed with 5-FU can also be helpful to reduce scar tissue.