Post Operative Fibrosis After Rhinoplsty

Question

i am 28yrs old now i had bulky nose and i underwent rhinoplasty on 2007 but i wasn't not satisfied with my nasal tip then again i underwent revision rhinoplsty on sep'2010 with another cosmetic surgeon. now i have thick fibros tissue on the tip of nose.its very hard on palpation.i didn't get this kind fibrous on my first surgery.i wasn't given any steroid inj in my revision rhinoplasty.will it get reduce with time. basically i have thick skin.

Peter E. Johnson, MD · Answer

There are many factors which ca contribute to a firm tip after rhinoplasty. Thick skin can be a cause, tip grafts are another. Also, with each revision it will take the tissue longer to soften and recover. If the nose otherwise looks well it is best to wait out the stiffness and avoid steroids. The tip will soften over time and 12 months may be a better time to judge.
	Best of luck,
	peterejohnsonmd

Mohsen Tavoussi, MD, DO · Answer

In my experience with many patients with thick skin who ahve rhinoplasty, specially revision rhinoplasty, need steriod injection to reduce scar formation. Thick skin needs aggressive defatting and thining in order to achieve adequate redraping of the skin. This in turn causes increase scar tissue formation that must be reduced with steriod injections.

Steven Wallach, MD · Answer

Stiffness after  rhinoplasty surgery is common and can take months or at least a year to resolve.  Good luck.

Erel Laufer, MD · Answer

Usually nasal stiffness subsides with time.On the other hand nasal fibrosis and thickness respond to certain degree to steroid injections..

Richard W. Fleming, MD (retired) · Answer

Healing can take much longer after a revision rhinoplasty, especially in patients with thick skin. I've seen this type of nose continue to improve for 18 months. Steroid injections may help - talk to your surgeon.

Michael Elam, MD (retired) · Answer

First of all it is important to wait some time to see if this resolves on it's own. It can take up to a year to see if this tip swelling goes down. There are many causes to swelling in the tip besides just thick skin and it is  hard to determine a course of action like steroids, when I am not sure of the exact procedures that were done during your revision rhinoplasty. I would go back and speak with your surgeon and discuss your concerns. If you do not feel comfortable with your surgeon then a copy of your operative report will be helpful to another surgeon during a new consulting phase. Hopefully someone will be able to answer your questions and give you a good evaluation and post surgical plan. Best regards!

Richard L. Dolsky, MD (retired) · Answer

Thick skin takes longer to heal and soften after Rhinoplasty. The skin does not model and take the shape of the underlying cartilage as easily as thin skin. During the operation, the surgeon may defat the tip and thin out the  thick, fatty skin over the tip. At first, this usually causes more fibrosis,  resulting in a stiff, swollen tip. It takes at least a year for 90% of this tip swelling to go down. I have found that steroid injections will speed up the healing process and reduce the swelling.

	There are two other possible causes of stiffness in the tip after Rhinoplasty. Your surgeon may have placed either a cartilage strut or graft in the tip. The cartilage is taken from the septum. A strut supports the tip and helps maintain the proper height. A graft is used to give shape and definition to the tip; this is especially true in revision Rhinoplasty and thick skin.

	Go back to your surgeon for his opinion and ask about the possible use of struts or grafts and treatment with steroid injections.

	Good luck,

	Richard L. Dolsky MD

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	Certainly some mild steroid injections in your tip may have helped with the scar tissue. However, if you had thick skin to begin with, then you may have had to have your tip defatted or thinned in the primary or secondary surgery.

	Best,

	Dr.S.

Post Operative Fibrosis After Rhinoplsty

Answers (8)

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