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

Question

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.

Elliot M. Heller, MD · Answer

MOST LIEKLY YOU WILL NEED A RHINOPLASTY REVISION. YOU MAY WANT TO SEE IF FILLERS CAN BE USED BUT IN ORDER TO CORRECT YOUR ISSUES A REVISION WOULD BE BETTER FOR YOU. YOU SHOULD HAVE A CONSULTATION WITH A NEW SURGEON AND SEE WHAT THEY SUGGEST FOR YOU TO DO.

Afshin Parhiscar, MD · Answer

Dear KenalogFrom what I can see in your pictures, your tip width to your nasal base width ratio is higher than what would be aesthetically pleasing for your nose. Based on that you would benefit from a revision procedure. Your skin has medium thickness and tip appears sebaceous. I recommend using skin care products to remove excess sebum and get to a healthier looking skin. (this in itself may give you a better look)Kenalog is not effective to thin the skin of the tip as its results are unpredictable in that function. it can be used to limit post op edema and scar formation when indicated. I think you would benefit from a consultation with an experienced and well trained plastic surgeon that is Board certified by the American Board of Plastic Surgery.

Andrew Kornstein, MD, FACS · Answer

Based on your photographs, it is possible that what you may be considering post-kenalog dents are actually tip cartilage edges. You appear to have tip cartilgage malposition. This can be corrected surgically if properly identified pre-op,.Also Ultherapy can be used instead of kenalog to reduce time fullness post-operatively

R. Stephen Mulholland, MD (retired) · Answer

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

Oleh Slupchynskyj, MD, FACS (retired) · Answer

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.

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

Answers (5)

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