I'd heard doctors sometimes do steroid injections for swelling post rhinoplasty. Why do they not do it regularly? Are there drawbacks or bad side effects to the injections? Are they very expensive? Incidentally, I was prescribed oral steroids for five days post rhinoplasty. Would taking them again be advisable?
Pros/cons of Steroid Injections After Rhinoplasty?
Doctor Answers 13
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.
Web reference: http://www.drhilinski.com/rhinoplasty-tutorial/steroid-injections/
These are all very good questions and reflect the nuances of practices between Rhinoplasty Surgeons. I have performed Rhinoplasty and Revision Rhinoplasty for over 25 years and have used post Rhinoplasty kenalog injections on numerous occasions when the post op course showed signs of increased subcutaneous scar tissue formation.
The rationale behind using steroid (kenalog) injections after a Rhinoplasty are as follows. Post Rhinoplasty swelling primarily occurs in and around the sura-tip (upper tip) area. Persistent swelling is replaced by scar tissue which blunts the shaped nasal tip cartilages created during the Rhinoplasty. An extreme example of this is called a "polly beak" deformity where the scar tissue acumulation actual deforms the nasal tip.
The more thick and oily the skin the more prone to prolonged swelling the skin is after a Rhinoplasty. We teach all our Rhinoplasty patients how to perform daily manual lymphatic drainage to the nose to reduce this swelling. Oral steroids can be given as can intra-op IV steroids as a precautionary measure against scar formation, especially in Revision Rhinoplasty or in cases of previous scar tissue formation.
Kenalog decreases swelling and scar tissue but can also cause the normal tissue to atropy and indent. For this reason, I dilute the kenalog 40 to kenalog 10 which decreases the likelihood of this happening. IMHO, I only use kenalog when it is clearly indicated and typically only during the first 6 months post op when the majority of the swelling occurs. IMVHO, if this scenario is followed there is very little downside to using Kenalog 10 when indicated during the first 6 months of the post Rhinoplasty process.
Web reference: http://www.drfpalmer.com/Rhinoplasty.html
At times an inordinate amount of scar and/or edema (swelling) can build up in the nasal dorsum or tip. Such as after a resection of a dorsal hump deformity giving the appearance that the deformity has been inadequately resected. Steroids after rhinoplasty are used as a means to reduce the amount of scar tissue and/or swelling that has formed. While being helpful, it does have potential side effects. It may cause atrophy of the tissues resulting in a depression, or cause hypopigmentation (loss of color) or even thinning of the overlying skin. Make sure you continue to follow up closely with your plastic surgeon as they will be best able to guide you through your post operative recovery. Best wishes.
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The use of steroid injections post rhinoplasty is dependent on the patient and their needs. Personally I feel most swelling will dissipate in due time and it is best to allow this healing process to resolve. On some patients with thick skin and different ethnic backgrounds steroids may be helpful in resolving some tip swelling. While they are helpful to reduce scar tissue you want to make sure that they are indicated for the problem being addressed. Steroids such as medrol dos pack may be given post surgery and are helpful in the healing process however would not typically be prescribed months after a procedure. Steroid injections are not expensive and if a patient of mine needed an injection it would be free of charge. I have an extremely busy rhinoplasty and septorhinoplasty practice and I can count on one hand the amount of steroid injections I have given in ten years. I hope this is helpful in opening up this discussion with your surgeon. Best regards, Michael V. Elam, M.D.
Web reference: http://www.michaelelammd.com
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.
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.
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.
Steriods can decrease swelling and may alter how the ultimate scar forms after a rhinoplasty. The advantages are it is non surgical. less costly than a surgical revision, convenient, and quick. However, it may be difficult to precisely estimate the exact result the steriod may have, if the steriod is injected too superficially it may cause changes to the skin.
I am not a big fan of steroid injection of the nose after rhinoplasty. A recent review of the literature on this procedure does not support long term success in reducing swelling. It may cause fat atrophy and cause hypopigmentation, and spider veins as well.
Steroids are helpful to reduce thickening just above the tip after rhinoplasty, but time to allow full healing works just as well. Steroids can cause dents, skin thinning, changes in skin pigmentation, and broken blood vessels called telangectasia. Surgeons can use steroids with care but beware of the downside. Oral steroids will not help you, so our vote is 'no' on that one.
Web reference: http://www.peterejohnsonmd.com/rhinoplasty
Injected steroids can cause skin atrophy and changes which may not be reversible. Oral steroids are of little help after the initial post op. Time usually is the best treatment for swelling. Donald R. Nunn MD Atlanta 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.
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