Considering revision to correct supra tip. Last kenalog injection of 40 mg by irresponsible surgeon left me with permanent dents even after 10 yrs still visible (I had 2 injections during my primary rhino). I have thick skin & a lot of scar tissue from primary rhinoplasty. Predicting I will need kenalog again in my revision. Am I risking more atrophy if this time around a skilled doctor uses a lower dose - 10 or 20 mg spaced apart if needed after my revision? My skin never healed fromkenalog 40.
Answer: Kenalog revision 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
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Answer: Kenalog revision 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
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February 8, 2016
Answer: Revsion Rhinoplasty - Atrophy from Kenelog. 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.
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February 8, 2016
Answer: Revsion Rhinoplasty - Atrophy from Kenelog. 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.
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