Deep scar, nose not straight from ill fitted cast following Rhinoplasty. Fat transfer fill in the hole & treat scar.(photo)

Question

My revision rhinoplasty took place Dec 2015. The cast wasn't secured properly and when removed my nose wasn't straight and a few months later a scar appeared. On 3 occasions steroids were injected by my surgeon. I then left it for a year to see if it settled then went back in Jan 2016 where steroids were injected. A month ago a fat transfer was done under the scarand I am left now with a raised hole which is yet to fully heal. Obviously losing confidence should I seek a second opinion?

Manish H. Shah, MD, FACS · Answer

Hello mulholc,Thanks for your question.My recommendation at this point would be to stop further intervention to your nose until the skin paddle can strengthen itself to heal.  More than likely, the steroids thinned the skin out and the fat grafts (under pressure) created a wound on the nose.  Your surgeon can start local wound care to heal up the area.  I usually recommend protein supplementation, use of Vitamin C, and local wound dressings.If the scar can settle down, you can come up with a number of options for aesthetic improvement such as:1. Laser resurfacing of scar2. Scar microneedling and PRP injections3. Scar excision with skin grafting4. Scar excision with local flap reconstruction5. Scar excision with forehead flap reconstructionIf your surgeon is uncomfortable with these type of nasal reconstruction options, then a second opinion with a revision rhinoplasty expert is in order.Good luck,Dr. Shah

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Steven M. Denenberg, MD · Answer

My response is qualified with the fact that I haven't had the chance to examine you in person, or to follow you through this. But. I just don't at all see where there was any possibility that a fat transfer could make any improvement in the scar. I'd get a second opinion on your care. I'm not sure I'd trust your surgeon's recommendations further.

Arian Mowlavi, MD, FACS (license on probation) · Answer

At this point, you need to leave you nose along so that it can heel and swelling resolve; I would not perform any revision for upto a year. Once the skin heals, you can consider a stonger graft than fat grafting.

Deep scar, nose not straight from ill fitted cast following Rhinoplasty. Fat transfer fill in the hole & treat scar.(photo)

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Answer: Tip scar gone bad

Answer: Tip scar gone bad

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Deep scar, nose not straight from ill fitted cast following Rhinoplasty. Fat transfer fill in the hole & treat scar.(photo)

Answers (4)

Answer: Tip scar gone bad

Answer: Tip scar gone bad

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Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.