Do Kenalog injections make that big of a difference in the final result? The surgeon refuses to administer them.

Yes, intra-nasal injections of steroids are very useful, esp in patients with thick skin. If used judiciously in the right patient, I have never seen an indentation. That is more common with thin skinned patients. Steroid induced atrophy can be reversed many times with serial injections of saline to flush out the depot steroid. Oral steroids are helpful, but not as effective as the injections.

Steroid injections are extremely useful in speeding the resolution of swelling and in some cases I am convinced make a difference in the final result. Swelling eventually can turn into scar tissue which can be permanent. Indentations are a risk but are unusual if injection is placed well below the skin and are temporary.

Great question. I use Kenalog injections often in my post-rhinoplasty patients. The injections are particularly crucial in patients with thick skin and those who have had prior rhinoplasties. The risk of skin indentation is low if performed correctly, and the indentations are generally subtle/temporary/reversible. The benefit outweighs the risk in my mind. Oral steroids can help too, but they don’t replace the benefit of Kenalog. I’d suggest seeking a second opinion, tbh. Pre- and postop Accutane therapy is another option for thick skinned patients.
Kind regards,
Dr. Mehta

The Kenalog injections are just as important as the surgery itself for patients who have thick skin in the tip of the nose. While the rhinoplasty procedure makes changes to the cartilage and bone structure, the steroid injections are managing the soft-tissue envelope over the framework of the nose. Both are equal Important.

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