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

i would highly appreciate ur advice on my nose tip fullness. i have thick skin & had a rhinoplasty to reduce tip and alar flaring. the initial result was very satisfying (3 weeks post op) though alot of swelling was still present.As the swelling went down by 6-7 months, nose looked great except under direct light or in photos. after 7 months, my nose started getting rounder at the tip & now its a BALL. By looking closely at my pics i can see a it was progressive. now what should i do?

Doctor Answers 4

Always complicated

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 ball


3) While more surgery is a last result you may consider getting injections of steroid and/or 5-FU to try to contract the skin


4) 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,


Madison Facial Plastic Surgeon
4.6 out of 5 stars 39 reviews

Rhinoplasty candidate with thick skin

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.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Nasal tip issues following a rhinoplasty

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!

Robert Galiano, MD
Chicago Plastic Surgeon
4.8 out of 5 stars 31 reviews

Tip

I would not rush to do anything just yet. Sometimes it can take more than a year for all the swelling to subside. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

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.