1 year after rhinoplasty, I think I have pollybeak. Shall I try Kenalog injection? (Photo)

Dear Docs, there is 1 year since my rhinoplasty. I had an internal one, that included septoplasty as well, and my surgeon used graft to enlarge the breathing channels because before the intervention, while i was breathing, the nostrils used to almost get closed. As you can see, i think i have a pollybeak. The first picture is made now, and the previous (collage) is comparison between 2 weeks and 6 months after surgery. Shall I try Kenalog injection? Any real risks or no chance for no result?

Doctor Answers 5

Polly beak deformity and should I have Kenalog injection?

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do NOT have a Kenalog injection. This is for  thickened skin above the tip. However this is not your problem.  It appears that the upper part of your bridge was made too low, the lower half of your bridge what is left too high, and the tip was insufficiently projected. See a very experienced rhinoplasty revision surgeon can show you many examples of his work in noses like yours and worse.  Do not rely on imaging. 

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

You have a rather prominent polly beak

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Hmm. It's usually doubtful whether Kenalog would help this long after surgery. But it depends a little on what the bulge is made of: if it's firm, like cartilage, there's no chance that the Kenalog will work. You might need a revision rhinoplasty.

First thing I'd do is read the "Web reference" link, just below this post. It contains a section discussing how to tell whether you should allow your primary surgeon to perform your revision.

I usually make a morph when I'm answering questions like this, to show what might be possible for your nose with another operation, but the photos you submitted aren't good enough to make morphs. At the *very* bottom of the Web reference page is a link to instructions on taking photos that are most useful for online consultations like this.

Steven M. Denenberg, MD
Omaha Facial Plastic Surgeon
4.8 out of 5 stars 42 reviews

Shall I try Kenalog injection?

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Most would agree that your photos do look like a polly-beak, or fullness above the tip of the nose. There can be several causes so we cannot say that Kenalog is the correct approach. Best see your surgeon so he can help determine what has caused things to be as they are.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Polly Beak Deformity and Kenalog Injections

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Kenalog injections in the nose can potentially cause a significant amount of damage. While they are occasionally helpful, one must be very careful with steroid injections in the nose. 

I believe the postoperative polly beak deformity is most commonly a result of inadequate nasal tip height and support. This results in a tip that drops below the level of the dorsal septal cartilage. Several techniques are available to increase tip height and support. These techniques include columellar struts, extended columellar struts, tip grafts and tip defining sutures.

Robert Morin, MD, FACS
New York Plastic Surgeon

Nose treatment after rhinoplasty

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Your photos show excess fullness in the nasal tip and supra-tip areas.  I think you would do best to follow-up with your rhinoplasty surgeon.  An exam of the nose is very important in determining the next best step.  Scar tissue can be well-treated with a series of steroid injections, with some surgeons using both a steroid called Kenalog and an anti-scar medication called 5-fluorouracil.  Depending on you r exam, you may need steroid injections or further surgery.

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.