Unusually Thick Scarring Between the Skin and Cartilage 10 Months Post Op

I had an open septo/rhinoplasty 10 months ago (major work in a 3.5 hour surgery). My nose got unusually thick scarring between the skin and cartilage, which makes it appear puffy like it is still swollen. My surgeon (an ENT and plastic surgeon who has an excellent reputation) only wants to remove the slight hump in the middle of my nose, but worries too much about removing the scarring or messing with the skin. Is there anything that can be done to get rid of the uniformed internal scarring?

Doctor Answers 8

Scar tissue and swelling after Rhinoplasty Surgery may benefit from triamcinolone (steroid) injections.

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I read your concern and wish I had a photo demonstrating the appearance of your nose. My concern about additional surgery, is that this may worsen your swelling. Ask your surgeon if a steroid injection might be helpful. And certainly do not hesitate to get a second opinion from another reputable, certified rhinoplasty specialist.

I hope this is helpful for you.

Regards from NJ:

West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Unusually Thick Scarring Between the Skin and Cartilage 10 Months Post Op

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I will have to assume that you have thick nasal tip skin and therefore excessive scarring. I have found aggressive thinning of thick skin is the only way to get a good skin draping over teh cartilages and get a refined tip. Postoperatively, steriod injections must be done to prevent scars.

Mohsen Tavoussi, MD, DO
Orange County Facial Plastic Surgeon

Subcutaneous Scarring after Rhinoplasty

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Your surgeon is correct when he shares his concern about removing subcutaneous scarring, However, this can be done. I suggest you get a second opinion from another experienced revision rhinoplasty surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Scarring between skin and cartilage after Rhinoplasty Surgery

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Hi scared nyc,

Scarring occurs with all plastic surgery, including rhinoplasty. Scar tissue forms between the skin and cartilage and any areas where incisions are located. Fortunately, scarring and scar tissue is minimal and unnoticeable in a majority of cases. Scar tissue, however, can be problematic contributing to undesired appearance, firm or stiff nose, and breathing problems. For example, scar tissue may form around the tip of the nose. Plastic surgeons may inject small amounts of steroids into the scar tissue to help reduce scar formation and reduce swelling.

Speak with your rhinoplasty surgeon. Only after a comprehensive evaluation can surgeon help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Rhinoplasty revision

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Without a photo or face to face examination it is impossible to know what is really going on. The key statements in your post are major work and open septo/rhinoplasty. Open approaches to nasal surgery remain swollen for much longer than closed approaches especially if a major surgery is performed. You even say it looks like it is still swollen and that is probably because it is still swollen. There is not much you can do to make the swelling go away more quickly other than warm compresses or oral anti-inflammatory steroid medications. You probably should not have any additional nasal surgery until you are at least one to one and a half years out from your last surgery. If you have additional surgery while the nose is still swollen the surgeon is not operating from baseline and cannot plan the appropriate surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Thick scar after rhinoplasty

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The thick scar over the bridge and over the tip of the nose may not be scar at all. Sometimes the hump reduction is large enough such that the skin cannot contract or shrink enough over the framework of the smaller nose. But even more commonly, the fullness is due to lack of support shaping the tip, or cartilage which is higher than the bridge at the nasal bone level. After ten months, scar is usually not the top diagnosis of problems you might have, and the slight reduction your surgeon suggests might be spot on.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Treatment for Swollen Nose after Rhinoplasty

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Even if you have a good relationship with your current surgeon and are planning on continuing treatment with him I think it would be a good idea to get another opinion. There is art as well as science when it comes to surgery and different doctors may have varying opinions on how to address an issue such as yours. In my own practice I will use injectable steroids for persistent or exaggerated swelling of the supratip area. In cases with long standing thickening I have found it possible to thin the scar tissue significantly without compromising the blood supply to the skin. Each case is unique of course, but the point is that you may options to address your concern and a second opinion appears to be warranted. Best of luck Dr Harrell

Nasal scarring

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Without a photo or exam it is hard to tell.  But, further surgery on your  nose will causes additional swelling, and myu cause thinning of the skin.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.