Is this just swelling? Would you recommend steroid injections 3 months post rhinoplasty? (Photos)

Question

I had rhinoplasty 3 months ago which involved an alar base reduction, thinning sides and of the tip. My nose looks far larger than it did before surgery and although I have been wearing tape at night, there has been no swelling reduction. It’s causing me great concern. I suggested steroid injections but my surgeon said there was a risk of permanent indentation and hyperpigmentation. I don’t want to ruin my face. Please let me know if this is just swelling and that it will go down. Thank you.

Lucas Bryant, MD · Answer

Hello and thanks for your question. Swelling after nasal surgery is very common, ESPECIALLY when the nasal tip is part of the procedure. When the nose is reduced/refined, that also means that the skin has to "shrink" down onto the smaller anatomy beneath it as well. All of these things are why rhinoplasty healing can take such a long time. Steroid injections are used more heavily by some rhinoplasty surgeons than others. Depending on the strength and the method used, the risk of any of the things your surgeon described can be very low, but no medical treatment is without risk. Keep in good communication with your surgeon, and remember that at 3 months you are still going to have quite a bit of swelling.

Lastly, depending on how you are taping your nose, taking the tape on and off can sometimes cause more inflammation and swelling, so make sure you tape per your surgeons recommendations and also remove the tape using a solvent and avoid pulling the skin up off the rest of your nose.

Warm regards.

Lastly, depending on how you are taping your nose, taking the tape on and off can sometimes cause more inflammation and swelling, so make sure you tape per your surgeons recommendations and also remove the tape using a solvent and avoid pulling the skin up off the rest of your nose.

Warm regards.

Michael Roskies, MD · Answer

Without feeling your nose, it would be hard to say definitively if you have persistent swelling just from observation. That being said, it does look like your nose is wider now than prior to surgery (based off of the photos you present) and one would assume that this was not the goal of your surgeon and is probably residual swelling. 
As you probably know, swelling will persist for 10-14 months, especially in the tip. Depending on how you are taping your nose, you may actually be making the swelling worse, so proceed with caution. 
Steroids are a great option for persistent swelling 2-3 months post-op and we commonly use them for patients in my practice. Because of your lighter skin type, I would say hyperpigmentation is not a big concern. If the kenalog (Steroid) is diluted to 1:2 or 1:3, the risk of indentation is decreased as well. I would insist your surgeon gives it a shot (no pun intended) or go see someone else who can help. 
Good luck.

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