How to Flatten Scar Post Rhinoplasty

Question

I had tip refinement and alarplasty about nine months ago, and I think the scar has completely matured. It's beginning to feel softer along where the incision was made, I think, but it is still raised causing the tip to be swollen (largely due to the thickness and oiliness of the skin I am told). Is there something I can do to expediate the flattening of the scar. Would kenalog be a recommended course of action to expediate resolution of scar and swelling at this point? Thanks and all the best!

Houtan Chaboki, MD · Answer

Tip swelling & incision scar from alarplasty are still improving at 9 months after rhinoplasty surgery. Speak with your rhinoplasty surgeon to help determine appropriate options for you.

	Rhinoplasty swelling occurs both on the outside and inside of the nose. It is normal to feel congested and have nasal obstruction and postnasal drip immediately after rhinoplasty surgery. Patients are generally "restaurant ready" and socially acceptable within 2 weeks. Most swelling after rhinoplasty resolves within a month. The final 20% of swelling takes a much longer time to resolve, up to a year or longer after surgery. Fortunately, this final swelling is usually only evident to the surgeon and patient.

	Rhinoplasty swelling varies greatly and is largely based on the areas of the nose treated, surgical approach to the nose (open or closed/endonasal), skin thickness, postoperative care, and your healing ability. The more extensive the surgery, the more you will swell and the longer the swelling will last. The tip of the nose holds onto swelling longer than the other parts of the nose. Open rhinoplasty, where there is an external incision at the base of the nose, swells more and longer than closed/endonasal rhinoplasty. Patients with thicker skin will also have more swelling.

	Keeping your head elevated, maintaining the nasal splint/cast, ice, arnica montana, and following your plastic surgeon's guideline may help reduce rhinoplasty swelling. Persistant swelling may also be reduced by steroid treatment into the nose.

Raffy Karamanoukian, MD, FACS · Answer

Alar scars can be white and visible. Hidef protocols can help with visible alar scars on the face. I see a lot of these in my office in Beverly Hills. Surgery is often not needed if lasers and HIDEF scar revision techniques are introduced. 
In our office, we combine treatments starting with topical pre-conditioning of the scars with Plato's Scar Serum for hypertrophy and Melarase PM for pigmentation. Fractional RF, laser, and micro fractional RF can help limit scar growth. Kenalog IIT can also help reduce scar thickness. For lip lift scars specifically, I use selective Hyfrecation to reduce scarring. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Minas Constantinides, MD · Answer

You have 2 issues, scars after alarplasty and tip swelling in thick skin after tip-plasty. The alar scars may be improved with steroid tape (Cordran), dilute triamcinolone (Kenalog), or a number of laser technologies. The tip swelling can be improved with triamcinolone (Kenalog) injections as well, although in thick-skinned patients it can take over one year for all the swelling to settle. Best wishes.

Sherry Li, MD, PhD · Answer

It is not uncommon to have raised or hypertrophic scars post surgery. Intralesional steroid injection most of the time can soften and flatten the scar. Additional popular options include pulsed dye laser or fractional laser. You should consult your surgeon and see what the best course should be.

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