Revision Rhinoplasty for Other Form of Swelling?

I am a 44 year old male, and had a Rhinoplasty revision done. It has been 10 1/2 months post-op. I had a Septoplasty and a Rhinoplasty to remove a large hump (cartilage). I am experiencing swelling in the morning, after a night of drinking. I have had five "kenalog" injections from my plastic surgeon, and have had a fraction of less swelling with every injection.

If the swelling is not scar tissue, and is a form of an edema, will a revision help? My plastic surgeon said he'd have to do it opened again. But, if I just got the septum fixed, he said that he wouldn't have to open it.

Doctor Answers 8

Septoplasty and/or rhinoplasty can both be done through a closed technique

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 The swelling that you're experiencing intermittently is normal interstitial fluid shift in the nose and face.  It becomes more noticeable after a rhinoplasty procedure. Kenalog shots that are placed in the internal portion of the nose help with dissolving scar tissue and removing lymphatic edema that gets trapped in the supratip area of the nose. Cortisone injections do come in two different strengths, Kenalog-10 and Kenalog-40. A septoplasty and/or rhinoplasty can both be done through a closed technique, not an open technique. A septoplasty will not affect any edema of the supratip area of the nose.
 For many examples, please see the link below to our rhinoplasty photo  gallery

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

A revision won't help swelling

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I don't think you can expect any improvement if your revision surgery is aimed at helping your swelling improve. Rhinoplasty is a delicate procedure and each revision carries with it more risk, in particular for a bad cosmetic outcome.

The operation needs to be focused on correcting a specific anatomic problem, and if this cannot be identified before the procedure, I would avoid any more surgery. It does sound like the kenalog injections have helped-- this, with time (sometimes 12-18 months for some open rhiniplasties) may be what it takes.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Swelling is normal in revision rhinopasty

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There are some general observations on revision rhinoplasty that can be made applying to your situation. It is not possible to give an exact assessment of your situation without seeing some pre-op photos to see where you started.
Swelling after any rhinoplasty can take years to resolve. Typically the bulk of the swelling is gone by 3 months though most noses get a little smaller and refined over the next months to years. A revision nose will typically take longer as there is more trauma and scar tissue to deal with. Thicker skin swells more and takes longer to heal than thin skin. Male noses also take longer to heal and swelling can last much longer.
One of the biggest factors in swelling after surgery is how much size reduction occurred. The more the nose was reduced the longer the swelling will last. Drinking, exercise and salt heavy diet can all cause temporary swelling in a healing nose.

At 10 months it is too early to jump right in and do another revision surgery. Share your concerns with your surgeon or consult a rhinoplasty expert.

Good luck and I hope this helps.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 65 reviews

Swelling after rhinoplasty can occur

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The skin soft tissue envelope is one of the most important elements in rhinoplasty surgery.  An experienced rhinoplasty surgeon has great respect for the skin and soft tissues, since they realize that this is the most difficult element to control. If this is damaged or the lymphatics disrupted it can be difficult if not impossible to re-mediate perfectly.  This can be a difficult problem to get a satisfactory result.

Robert Mounsey, MD
Toronto Facial Plastic Surgeon

It is most likely to be cartilage.

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 Chances are that it will not resolve after this amount of time and steroid injections. It is probably cartilage or excess scar tissue and this will require a revision. You may seek another opinion from an experienced  revision rhinoplasty surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Be careful of steroid injections

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Five steroid injections may have helped with some swelling, but steroids have a way of thinning skin and causing vascular proliferation (additional blood vessels). Your skin is thick, not uncommon for a 44 year-old man. No matter how little swelling you have, the thick skin will not allow the underlying architecture to show like you see in young women with thin skin.

I am not sure that surgery will help you any more. I would also be very careful with more steroid injections. Your nose looks relatively straight and it is not uncommon to have it pull down when your smile. There is a small procedure that can cut a muscle that predisposes to pulling down. It can be done from within the mouth, but the results can be variable. Ask your doctor about it, and consult with someone used to doing multiple revisions.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

It sounds as if you are still healing.

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With revision rhinoplasty, a surgeon typically reopens previously operated upon tissue. This can place even more scar into the surgical space than before. Also, the lymphatics or fluid draining vessels may be slower to recover creating prolonged edema. The fact that steroids are helping indicates that the inflammatory process that is part of normal healing is being controlled.

A revision for swelling will probably only make things worse because the tissues would get traumatized for a third time. It is very easy to create a lumpy, amorphous nose from too much surgery. Unless your breathing is severely restricted, I would stop touching the nose for a long while to let your body settle itself down. The steroid injections can certainly continue but only if the benefits outweigh the risks.

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 reviews

Surgery does not help swelling

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It is unclear what your problem really is. If it is truly swelling, then surgery will not help. It can take a very long time for swelling to resolve after rhinoplasty and it sounds like the steroid injections are slowly working. If the issue is anatomic (residual hump) and not truly swelling then you may need revision surgery. Good luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.