Should I Get Steroid Injections to Thin Skin? (photo)

Question

I had rhinoplasty done 9 mon. ago. My tip is still round & bulbous. My PS suggested steroid injections to thin the skin. I have been researching it & I'm scared to do it due to atrophy stories. I bruised terribly after surgery and am afraid that I won't react well to the shot, either. After viewing my photos, do you think steroid injections would be beneficial? I don't feel that my nose has changed much at all and I want to see what I hoped & paid for - but don't want to risk looking worse.

Richard H. Tholen, MD, FACS · Answer

I have seen too many over-aggressive steroid injection disasters, and I appreciate your concerns. That being said, IF your surgeon is properly conservative in BOTH dosage and strength of the steroid injections, and you are comfortable with "creeping up" on the results you seek, this can be a powerful tool to improve results and avoid re-operation (which could result in even more and worse scar formation).

	I usually start steroid injection sooner than 9 months post-op (but no sooner than 3 months post-op), recommend steroid injections no more rapidly than every 8 weeks, and ALWAYS start with a very low dose and very low strength, telling my patient that it is actually OK if they see "no response" from the first steroid injection. If a small response is seen, I simply do another injection at the same low dose and strength, thereby avoiding an unanticipated "over-response" and dent/atrophy/onion-skin thinned skin. Too many steroid users go for the "killer dose" initially, and if it's too much, it's too late.

	If no response at all is seen, I usually double the strength and reduce the dose, again looking for only a small change. I can always do more, but cannot undo a totally screwed-up steroid injection (BTW, "screwed up" is a medical term most lay persons understand! In this case it means "too strong" or "too much.")

	Talk with your surgeon and get details of dose/strength FIRST. By way of comparison/yardstick, here's what I use for starters: 0.1cc of 10mg/cc triamcinolone per spot of scar tissue. Do not inject close to the surface of the skin. If no response at all at 8 weeks, I will use 0.05-0.1cc of 20mg/cc triamcinolone. If I see a response at all, I stay at this strength and dose accordingly. If still no response at all at 8 weeks, then I will try the tiniest dose possible of 40mg/cc triamcinolone. I do not recommend the stronger fluorinated steroids; they are too strong. But I cannot tell your surgeon what to do. You do, however, have the right to ask what, what strength, and how much is used! Good luck and best wishes! Dr. Tholen

James M. Ridgway, MD, FACS · Answer

The nasal tip holds onto swelling for the longest period of time after rhinoplasty. You will continue to see refinements and improvements over time. Patience is advised.

Be healthy and be well,

James M. Ridgway, MD, FACS

Michael A. Persky, MD · Answer

Hi HBgirl,

	 

	We love Huntington Beach.  I would not use steroid injections in your nose at this point.  With time and patience, your nasal skin will naturally thin over time.  If after two years you are still concerned, then re-visit.  Enjoy your new and evolving nose.  Good luck and be well.

	 

	Dr. P

Richard W. Fleming, MD (retired) · Answer

You have diffuse swelling in your tip 9 months after rhinoplasty surgery. This should improve with time. Steroids are beneficial to decrease localized swelling which you do not have. At this time I would advise you to continue to be patient.

Should I Get Steroid Injections to Thin Skin? (photo)

Answers (4)

Answer: Steroid Injections for Bulbous Tip

Answer: Steroid Injections for Bulbous Tip

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Should I Get Steroid Injections to Thin Skin? (photo)

Answers (4)

Answer: Steroid Injections for Bulbous Tip

Answer: Steroid Injections for Bulbous Tip

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Everything you need to know about Rhinoplasty

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