1 year post septohinoplasty. What are my options to address problematic swelling/scar tissue? (photos)

Question

I had a septorhinoplasty and turbinate reduction in November 2020. Recovery was without issue. The septoplasty and turbinate reduction have been great. The rhinoplasty has some issues. Made an appointment recently 1 year after the procedure. Pointed out areas with issues. Dr provided a Kenalog injection for lump marked "1". What are my options to deal with the areas of persistent swelling or scar tissue, especially the tip? Would kenalog injections fix this? Would it help to narrow areas 3&4?

Mark K. Markarian, MD, MSPH, FACS · Answer

Hello and thank you for your question.  Although an exam in person is ideal, from your photographs alone it appears that you can benefit from a revision rhinoplasty to improve both the irregularities of the dorsum of you nose and a tip rhinoplasty where the nasal tip cartilage is modified for a more refined, symmetric look.  The modification of your dorsum can be performed with soft tissue grafting and the nasal cartilage can be modified by cartilage trimming, stitching or grafting.  If your septum has any residual deviation and you have breathing difficulty, a revision septoplasty may benefit you as well.

The next step for you is to find the right aesthetic plastic surgeon.  In your rhinoplasty consultation, be sure your surgeon addresses all your aesthetic goals and concerns specifically, and discusses the surgery details including the position and size of the incisions used (with actual photographs and not just digital animations), the risks and benefits of the procedure, recovery time, and post-operative course.  Also, be sure to see plenty of before-and-after pictures in men who have a similar nose appearance to yours, and preferably at different time frames (3 weeks out, 3 months out, etc) to more accurately predict your own surgical outcome.

After seeking out a board-certified plastic surgeon who specializes in aesthetic plastic surgery, I think the most important component of the consultation is to establish a good connection with your plastic surgeon.  It’s the connection that allows you to clearly define your desired nose outcome goals, the first step of this whole process. If you don’t feel you have a good connection with your plastic surgeon after your consultation, he/she may not be the best surgeon for you.

For more information on rhinoplasty, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Weewoo91,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Raghu Athre, MD · Answer

1.  What were the issues during your rhinoplasty?

PLEASE REMEMBER the following is based only on pics.  THERE IS NO PHYSICAL EXAM, and no analysis of prior operation, and what was done.

Overall, the appears to be:
1. a slight amount of scar tissue over the dorsum at the level of the cartilagenous midvault.
2. Asymmetry of the lower lateral cartilages and tip.

At a year post-op after the primary surgery, most of swelling related issues should have resolved.

Kenalog MAY help with certain areas to cause contraction of scar tissue.  However, KENALOG is not a cure-all.  I feel that kenalog is our go-to medicine.  This is primarily because there is nothing else.  However,kenalog is not without some risk.  Kenalog can cause a hyperactive result by causing fat necrosis and can melt some cartilage.

Rec's.
1.  Have a talk c your surgeon
2. Think about whether you are satisfied with your result.  I used the word satisfied, not thrilled.  If you are not satisfied, consider revision.  Know that revision has risks.  Re consider whether you are satisfied knowing what those risks are.  If you feel risk/benefit ratio benefits you, proceed with revision.  Otherwise, consider a small amount of HA filler as camouflage.

1 year post septohinoplasty. What are my options to address problematic swelling/scar tissue? (photos)

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1 year post septohinoplasty. What are my options to address problematic swelling/scar tissue? (photos)

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Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.