11 months post op kenalog injections or de-fatting tip? Surgeon wanted to defat the tip but I said no, now I regret (Photos)

While ANY revision rhinoplasty should be evaluated in person I can make a few comments based your your photos.1) Thick skin continues to contract long after surgery. If the structure underneath the skin is not strong enough then the results can be an amorphous tip. A tip whose shape is blunted.2) The smaller tip (in your situation) can look "big" because of unfavorable shadowing of an isolated tip. Your photos do show this tip of coinfiguratuion. The line from the tip to the nostril is pinched which can make the tip look like an isolated ball3) While more surgery is a last result you may consider getting injections of steroid and/or 5-FU to try to contract the skin4) If this is not successful you may be able to undergo a revision to add key elects of structure to better improve the highlights and shadowing of the nose,

Thick skin especially in the tip of the nose is a significant impediment to seeing refinement of the nasal tip cartilages after a rhinoplasty procedure.  To minimize edema in the tip of the nose, consider additional steroid shots, taping, and a low-salt diet.

Since it has been nearly a year following your rhinoplasty, I think it is safe to consider consulting with your surgeon once more and discussing your concerns. He or she will be able to review your photos post-surgery and can best determine what is causing the issues with your tip appearance. Defatting the tip will not necessarily help your results if they are due to poor nasal tip support and scar contracture. As a matter of fact, in that case you may benefit from a tip graft and revision tip surgery to provide the support needed to counteract the forces of scar contracture. This may need to be done with nasal skin thinning and removal of excessive scar tissue, if present. However, this really needs to be determined via an in-person consultation. I am skeptical that kenalog will be of much use at this point, and I am also skeptical that simple "de-fatting" is going to be useful, since at this point much of the issues you seem to be concerned about are related to buildup of scar tissues and possible lack of tip support. Regardless, also recall that noses change subtly even after many years, which is why I consider this a 4-dimensional operation, and that even a perfectly executed rhinoplasty may sometimes take a turn for the worse during the healing process. Your surgeon is best positioned to provide guidance and advice at this point. Good luck!