Scar tissue after rhinoplasty - can it be removed and will it grow back?

Scar tissue in the tip or just above the tip is one of the limitations of rhinoplasty.   Meticulous and precise dissection during surgery limits injury and postoperative swelling which often leads to permanent scar tissue.   Close follow up with postoperative steroid injections is highly successful in further limiting permanent scar tissue and sometimes can even result in resorption if scar tissue minimizing the need for revision. Nevertheless in a small subset of patients scar tissue forms months after the initial surgery, and does not respond to steroid injections requiring revisional surgery to remove.   Usually that is successful  but in my practice is combined with monthly steroid injections for at least 3 months.  

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. Scar tissue forms with most rhinoplasties to a certain degree. Excess scar formation is managed best with steroid injections in the postop period. Thicker skin tends to form more scar. 
Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.  
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

When the nose heals after rhinoplasty, the body produces healing tissue to allow the soft tissue envelope to re-adhere and drape over all of the structure (bone and cartilage) of the nose.  The amount of scar tissue is variable person to person.  In general, the thicker the skin is to begin with, the more scar tissue will form.  Over time, through a process of soft tissue remodeling and contraction (sometimes called shrink wrap), the soft tissue envelope thins to better show the definition of the nose. However, the capacity of the skin to contract is finite and if there was too much reduction to the size of the nose relative to the ability of the skin to contract, the scar never thins to the ideal point, resulting in permanent thickening.  This is most common in the lower third of the nose, especially just above the tip after a hump is lowered.  This specific problem is called a polybeak deformity.  The best way to prevent such problems is to be strategic in the surgery and not to reduce the nose beyond the ability of that individual skin envelope to contract.  The thicker the skin, the less size reduction should be attempted and the focus should be more on shape improvement.  If this problem happens, subsequent treatment must be thoughtful and deliberate to prevent further problems.  I usually use the following guidelines when treating someone with an excess scar tissue or polybeak deformity following previous rhinoplasty:1.  Start with conservative measures such as kenaolg (steroid) injections or taping.2.  Wait at least 1-2 years before considering revision--thick skin takes longer to settle and contract.3.  If revision surgery is performed, avoid treatment simply through "scar removal" or soft tissue thinning.  This will tend to stimulate more soft tissue injury and more scar tissue.  Or even worse, if done aggressively can cause vascular damage and unevenness/atrophy to the skin envelope.  Revision should be focused on shape improvements--sometimes requiring that the nose be made bigger but better in shape and proportion to stretch the excess skin and scar and result in improved shape and definition.These concepts are advances rhinoplasty topics and as such this type of problem is best tackled by an experienced nose surgeon with lots of revision experience.

Scar tissue formation after surgery is the natural and normal way the body heals. After rhinoplasty, what we don't want is aggressive thickened scar tissue formation. This is controlled after surgery with compression, taping of the nose and conservative injections, over months with dilute steroids and 5FU. Retained strong residual architecture, cartilage and bone is required. The surgeon can't cut out too much structure. That's why I perform Reduction Structured Rhinoplasty not just Reduction Rhinoplasty.