Why is it safe to receive kenalog injections for cystic acne, but not for prolonged scar tissue/swelling in rhinoplasty?

I'm 4 months post op & massaged the nose too hard 1 month ago. Btw. my thick skin & bad timing, my nose looks awful after healing nicely in the first 6 weeks-its thick, lumpy, swollen up to the size it was when the cast came off. There's big ball of scar tissue hanging down/around the tip. I don't drink or smoke, I'm not out in the sun much. I have a Medpor implant that has settled in (surgeon checked). He refused giving me even a diluted kenalog injection. I get them for cysts w/out a problem.

Doctor Answers 2

Kenalog following rhinoplasty

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Kenalog in high concentration is fine following rhinoplasty at 4 months provided it is not near the medpore implant. Is the implant near the nasal tip? Is it the tip that is thick?

I often pre-operatively plan injections post op in patients with thick skin

Toronto Facial Plastic Surgeon

Rhinoplasty: Steroid injections ok?

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You ask very good questions that do not have a simple answer.

With cystic acne, steroid injection are common and could be considered routine treatment. They stop the inflammatory process and hence can minimize the scarring. The risks of the injection is injury to the skin and surrounding tissues that can be involutional (sunken out areas). Risk-benefit ratios favor the injections. This means benefits can be high with low risks.

With a rhinoplasty, the risks are higher. This is extra important as you have an implant in place. Steroid injections could shrink the tissues and injure the skin. This might under the wrong circumstances lead to the implant getting exposed. This could be a major problem. Your doctor probably believes the risk-benefit ratio is not good. This means the risks are too high.

Steroid injections after rhinoplasty without implants can still be tricky. Some doctors will do this frequently and others practically never. The caution is that the steroids can cause injury to the tissues that is permanent. Time is another option. Waiting and having extra patience. Swelling usually will dramatically improve. But it can take a lot of time. And this is not easy!

I hope this helps!

Dr Chris Saunders

Christopher Saunders, MD
Wilmington Plastic Surgeon
4.8 out of 5 stars 78 reviews

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