Too late for Steroid injections years after rhinoplasty? (Photo)

Question

Hello docs, basically i got a rhinoplasty in 2017 with a shady doctor who no longer has my respect and i will not return back to him. He left me with a bulbous tip which makes my face super asymmetrical. After hearing about Steroid injections, would they be effective in reducing/eliminating the bulbous appearance years after the surgery? Perhaps, could there still be scar tissue making the tip big/asymmetrical? Your opinions are appreciated, thanks

Jeffrey M. Darrow, MD · Answer

There are a number of factors which could contribute to your rounded nasal tip. It could be the thick original nasal tip skin, poorly positioned cartilage in your nose, scar tissue contraction due to poor structural support under your skin, etc.  I do not believe, without knowing your surgical background and having the prior surgeons operative note and your before and after pictures from all views, it would be wise to simply recommend steroid injections, as I also don’t feel they would be effective at this stage.  My best advice would be to have an in person consultation with a rhinoplasty specialist for a detailed examination, examination of the prior surgeons operative notes and your before and after pictures from your first surgery. Best wishes.

Nima Shemirani, MD · Answer

Hi @jd432! I'm sorry you are not happy with your prior surgeon. That being said, I don't believe you will benefit from a steroid injection. You would get the most benefit from a revision rhinoplasty. A non-surgical approach would be hyaluronic acid dermal fillers to help with the bulbous appearance. This is a temporary fix and can last up to a year.

Jonathan Kulbersh, MD · Answer

Thank you for your question. You may be a candidate for a non-surgical rhinoplasty procedure that uses hyaluronic acid dermal fillers to correct bumps and asymmetries. An injectable formula like Restylane® or Juvederm® may address the bulbous appearance you describe without the need for revision surgery. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon you trust who can assess your situation and help develop the best treatment plan for your needs.

John Layke, DO, FACS · Answer

Thank you for your question.  Firstly, I am sorry that you have had a bad experience during your rhinoplasty journey.  I see an asymmetric, bulbous tip with a poorly healed columellar scar.  If you don't trust your original surgeon, I would search for a Board-Certified Plastic Surgeon or Facial Plastic Surgeon highly experienced in rhinoplasty.  Although steroids can help with postoperative swelling, I feel that the actual underlying structure of your nose needs to be symmetrized.  In short, a steroid shot won't do the trick...

Gurkan Kayabasoglu, MD · Answer

Hello. Steroid injections are only used to thin thick skin and to remove minor irregularities. You have a very serious skeletal disorder. The reason for the asymmetry is that the new nasal skeleton was not built correctly, so steroids will never help you, in fact they will do a lot of harm, be careful. I’m the only triple board-certified facial plastic surgeon all around Europe. I’m just focused on this issue. I am a doctor who goes to almost every country in the world and explains my techniques to important doctors with the seminar invitations I receive, so I am definitely the only doctor who can perform your operation very comfortably and successfully. You can get more detailed information about me, ask all questions about your case and sending your photos to my assistants at the number on my profile (+90 539 204 40 90). You can also book an online consultation and discuss your problems with me. With all respect.

Marc Polacco, MD · Answer

Thank you for your question. Based on your photo, it appears that there is a polly beak deformity. There are a few things that can cause this, one of which is scar formation in the supratip region. However, excess cartilage could also contribute. At this point steroid injections are unlikely to help very much (most effective in the first month or two), but then again there really isn't a lot of downside to trying. I'm sorry you're going through this, and I wish you all the best.
-Dr. P

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! It's possible that steroids can still work. I would start with something like Kenalog and increase the amount and frequency over time. If no improvement is seen, a revision procedure would likely be needed to see if cartilage grafting is not appropriate or scar tissue is present. There are options, but starting conservatively would be best. Hope this helps.