Kenalog likely need revision. Is it risky if I still have dents/indentations from previous injections in my rhino? (photo)

Dear
Kenalog,

Thank
you for your clinical post and posted photographs. Although difficult to tell from the
photographs submitted, it does appear that you still have some slight super tip
fullness. The use of Kenalog is quite
common in the early postoperative phase to reduce edema. The exact concentration and location of these
injections is part art and part science.
From your soft tissue overlying skin appearance, it appears there is
some indentations or irregularities as well as a thick, sebaceous, porous skin.

My
advice at this point would be to very carefully seek out advice from plastic
surgeons and rhinoplasty surgeons with experience. I have been performing rhinoplasty surgery
for over 20 years. I was fortunate to be
trained in both plastic surgery and ear/nose/throat- head/neck surgical
oncology. Rhinoplasty is a big part of
my clinical practice and I would break down your concerns into two components. First of all, the overlying thick sebaceous
skin and post-Kenalog indentations. Simply addressing the dorsal nasal skin with a series of fractional
resurfacing technologies, both carbon dioxide fractional or radiofrequency
needle and infrared fractional techniques will significantly improve the dorsal
nasal skin so that it is much smoother.
Looking at your profile photos supplied, the super tip fullness is very
slight and a dorsal nasal injection and injection rhinoplasty may be all that
you need and you can avoid surgical revision.
If you did want to drop your nasal tip, this of course would require
nasal surgery, but it is again fraught with the same sorts of risks and postop
complications and delayed swelling and edema that you experienced the first
time, if not more so.

At
this point in time, I would seek out the consultation of physicians that have
experience with secondary and primary rhinoplasties. I generally conduct all consultations with a
computer imaging session to show the type of outcomes that are reasonable to
expect and this computer-simulated surgery helps patients understand what is
possible and what is generally not.

A
careful and sequential approach to improving your dorsal nasal outcome is
important. There still appears to be a
bulbous tip formulation to the width of your nasal bridge and this may need to
be addressed at the same time as a surgical revision.

For
more information, please review the link below.

I
hope this information has been of some assistance and best of luck.

Sincerely,

R.
Stephen Mulholland, M.D.

Certified
Plastic Surgeon

Yorkville,
Toronto

Hi,In order to refine your tip a revision rhinoplasty is necessary. The indent can also be fixed at the same time. However, if you're only  looking for correction of the indent, you can try several fillers for this. Using kenelog is an art form, deciding on the right dosage can be tricky but indents from kenelog can be repaired.Best,Dr.S.