Steroid Injections for Decreasing Nose Bridge Height?

Dear rhinoplasty patient from Los Angeles,
Steroid injection will not resolve the prominence of your nasal bridge. The solution is removal, reshaping of the graft, and then placing back in. Steroids usually help scar and prolonged swelling. Talk to your surgeon, he should be able to do that for you. Good luck and good healing.
 

In general, it is not a good idea to do steroid injections in revision rhinoplasty except if it is carefully placed in a patient with thick skin in the supratip area and is given early post operatively. One must make sure it is not intradermal, but in the deep subcutaneous tissue in low doses. I would not recommend injecting anywhere else, certainly not to reduce the dorsum of the nose after a revision rhinoplasty. It will only cause skin atrophy, skin discoloration and excess telangiectasia (broken blood vessels) of the skin.

Steroid shots will help only if the height is caused by scar tissue. If the bridge feels hard like bone, then it is probably the rib graft. If this is the case, patience is your best ally as sometimes there is some resorption of the rib graft in the first year and your bridge may end up looking just fine. If not, it may be removed, re-contoured, and replaced.

If excessive scar tissue formed on top of your rib graft, judicious steroid injection into this subcutaneous scar tissue COULD help to minimally reduce the unsightly protrusion . . .BUT it is much more likely that the graft is excessively large for your desired nasal appearance, and simply needs removal, reduction, and replacement.

I share my colleagues' concerns that steroid injection in the vicinity of a graft is not recommended. Third time revision can be scary for the patient, and experience in revision rhinoplasty is crucial to avoid damaging the circulation to the skin, which could result in healing problems or even skin loss and severe scarring. This could be significantly more detrimental to your appearance than a too-high bridge.

Hi Tiana,

You should consider going back to your surgeon. He can remove the graft and reduce its size and place it back on your nasal bridge. This should be fairly easy and should not cost you much.

Please do not use steroid or Kenolog injection as they can thin your skin and make the problem worse.

Good Luck,

Dr. Sajjadian

Rib grafts are often unintentionally over-sized resulting in a high bridge.  The good news is that the graft can be removed, reduced in size, and replaced.

Thanks for yout question -
Steroid injection is not a safe way to correct nasal contour. It is difficult to control the end result and you are likely to have skin hypopigmentation, possible graft infection and tissue atrophy.
It would be much better to address the position, shape and size of the graft. This would likely require additional surgery.

Injections of kenalog and steroid preparations into the superficial aspect of the nose can cause premature atrophy of overlying soft tissue and accentuate bony deformities and cartilage assymetry. Discuss these options with your treating surgeon.

A more appropriate therapy would be to inject absorbable or temporary facial fillers such as Restylane or Juvederm. Patients undergoing dorsal bridge adjustment with facial fillers acheive more harmonious nasal profiles.

Return to your surgeon and have him remove part of the graft lowering the height. Unfortunately, steroid injections will not work and may make it worse. 

Hi Tiana,
Steroid injections will not significantly reduce the dorsal height of your nose 6 months after rib cartlilage grafting. You should discuss your concerns with your rhinoplasty surgeon and consider a revision surgery in 6 to 12 months if the condition continues to trouble you. Good luck and be well.
Dr. P