Pros/cons of Steroid Injections After Rhinoplasty?

Steroid injections are usually used for persistent swelling or subcutaneous scar tissue. It is always best to be patient and allow the nose to fully heal after a rhinoplasty before considering steroid injections.  It is important to realise that the technical part of the surgery is predictable but that after surgery healing and swelling may be unpredictable which is why such injections may be needed in very select cases. Under these circumstances you need to be guided by your surgeon.   Remember that it can take a nose around a year to fully settle after surgery and many issues resolve spontaneously. The most common area where steroid injections can help is in the supratip area where fullness can mask the supratip definition.  However, injections may be administered to other areas around the tip or the rest of the nose where there may be persistent issues. It is very important that injections are administered deep under the skin in a very small dose since superficial injections can cause skin atrophy ( white patches) and indentations).

Steroid injections are used in a small percentage of patients with prolonged supratip swelling. I use a very dilute Kenalog preparation so there are no problems with skin depression. The cost is often times included in the surgical price, if needed. There is really no reason to take oral steroids.

Steroid injections are sometimes used after rhinoplasty surgery for various reasons. Steroids reduce inflammation, therefore reduce swelling and prevent excess scar tissue formation. Therefore, use of  steroid injections can be beneficial to the healing tissues in some conditions where the nasal skin is thick or excessive and prominent edema is seen. The problem however is that steroid injections can also cause atrophy of normal tissue, resulting in unwanted skin thinning and depressions of the skin. Its use should be only limited to unwanted long-lasting swelling and very thick skin management. 
Hope this helps,Ali Rıza Öreroğlu, MD FEBOPRASEuropean and Turkish Board Certified Aesthetic, Plastic and Reconstructive SurgeonIstanbul, Turkey

We only use dilute triamcinolone acetonide injections in the supra-tip area, just above the tip, when there is swelling that resembles a polybeak. Nasal steroid injections can rarely lead to skin atrophy, indentations, telangectasias, or whitening of the skin. Hope this helps. Dr Joseph

Swelling
after rhinoplasty particularly in the nasal tip is normal and is a part of
normal healing. There is little to stop the tip of your nose swelling as only a
small volume of swelling can be visible in this area of the nose.

A
combination of factors will help with reducing swelling one of which is the use of
anti-inflammatory treatments to the tip of the nose, including steroids. Dr. De
Silva advocates the use of such medicine in most patients to speed up the
resolution of swelling and ensure faster recovery after surgery. Although the
final results of rhinoplasty can be more than one year after surgery, the use
of anti-inflammatories can shorten this period considerably. Patients with
thicker skin which includes certain ethnicities and ethnic rhinoplasty, may
benefit from more than one anti-inflammatory treatment. As with every medication there is always a small
risk of side effects and anti-inflammatory medications are not suitable for
every patient. Particularly in patients requiring more complex revision rhinoplasty, caution is required as steroids may rarely cause thinning of the skin resulting in a
depression, or loss of colour (termed hypo-pigmentation.

Steroid injections following rhinoplasty are indicated when there has been excessive scar tissue production deep to the skin - this manifests itself by the appearance of swelling. This is most commonly in the supratip (area just above the tip) or tip regions. Steroid injections typically take about 2-3 weeks to start to work. They should be used judiciously as when too much is injected or injections are performed to frequently, they can cause excessive thinning of the skin and contour irregularities, or loss of pigmentation that can take a long time to resolve. If further injections are required, they are typically done at least 6 weeks after the previous injection. It is better to be more conservative using steroid injections following rhinoplasty than be too aggressive.Some surgeons prescribe oral corticosteroids for a few days following rhinoplasty in the belief that this may help reduce the early postoperative swelling resulting from surgery, however, the clinical studies about the effects of oral corticosteroids are equivocal. Prescription of oral corticosteroids is largely done based on the surgeon's preference. Personally, I do not prescribe these to my patients. For persistent or prolonged swelling after rhinoplasty, oral corticosteroids are likely of limited benefit.

   I have not found the need for steroid injections, but it is not unreasonable.  The risks would include skin pigmentation changes that can be very difficult to treat and depressions in the skin.  Kenneth Hughes, MD Los Angeles, CA

This happens to be a somewhat controversial topic when it comes to rhinoplasty surgery healing. Below is a link to a page we have on our website that discusses this in a little more detail. I hope it provides you some good insight.

Kenalog combined with 5-Flourouracil yields a fantastic result when used post-operatively to help reduce swelling. There are some possible side effects that may occur such as white spots on the skin and indentation. But I have performed hundreds of these injections with no complications. Treatment for swelling really depends on the individual needs of the patient, and I would recommend speaking with your surgeon to see what he/she advises. I hope this helps, and best of luck to you. 

Steroid injections to prevent or reduce scar tissue after a rhinoplasty procedure can be beneficial but also has the potential to create depressions that are difficult to correct. Therefore, it is prudent to follow up closely with your rhinoplasty surgeon and their judgement as it may or may not be necessary to have this treatment.