Aug 2

Steroids and Rhinoplasty

Please note: We are happy to see that our blog is of some help to many of you who are considering or recovering from rhinoplasty. While we would like to address your concerns directly, we are not able to dispense medical advice over the internet. Your own surgeon is your best resource in the first weeks and months after surgery. If, after 5-6 months, you continue to feel unhappy with your result, feel free to contact us via our practice site www.beverlyhillsprofiles.com and we can arrange time to discuss your concerns. All the best for a happy outcome.


How fast you heal after rhinoplasty is a major question on everyone’s mind, whether it’s your first surgery or a revision. No matter how careful or meticulous your surgeon, there will still be some swelling afterwards. Your nose will not look exactly like the computer-imaged ‘after’ picture as soon as the splint comes off. It will take some time for your skin to contract and ‘shrink wrap’ down onto the new structure underneath to really give your nose a lot of definition. Of course, the goal is to get you feeling good about your nose as soon as possible and we do whatever we can to make sure that happens. We want you to skip the puffy stage and move straight on to liking your nose…really liking it. That’s why we are fans of asking patients to tape their noses at night after surgery and of using steroid medication, both during and after surgery, to speed up healing.

There are a number of studies that have supported the use of steroids in rhinoplasty to reduce swelling, bruising, and discomfort from surgery. We offer most of our patients a short course of oral steroids after surgery. When the splint comes off 6 days later, we find it makes the difference between “Wow! I love it already!” with steroids and “I can see it’s gonna be great but it’s puffy right now” without steroids. Beyond the first month, we find judicious use of steroid injections to be enormously helpful in reducing swelling in certain stubborn areas of the nose like just above the tip where the skin is thicker.

Below is an example of how steroids help healing after rhinoplasty. Photos are shown Before, 6 weeks, and 4 months after surgery. Oral steroids were not used. Notice how steroid injection helps to settle puffiness in the bridge and around the tip. Neck liposuction was also performed.
Healing after Rhinoplasty

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89 comments

89 Comments so far

  1. Mike August 3rd, 2010 1:44 pm

    Hello – Your blog is very helpful; Thank you for this posting. As I posted on one of your previous blogs entitled “why does my skin thickness matter”, I mentioned that I am now 4.5 weeks post op (revision rhinoplasty) and that I have kept up with the nasal exercises well, and I managed to keep my bone structure narrow. As my doctor puts it, I’m now in “maintenance mode” for the next couple of weeks. However, my skin has contracted outward to the point that my nose looks almost the same as it did prior to surgery (not necessarily swollen, but a bit squishy and tissue around the walls of my nose which are hindering the narrow effect that i desire). Is this normal?

    My doctor mentioned steroid injections for my next visit but also that the treatments must be staggered out. He doesn’t think that taping will help my nose. This is obviously a little discouraging but I can only hope that catabolic steroids will beat the tissue down enough to remove the space between my modified nasal structure and the excess tissue.

  2. admin August 4th, 2010 12:36 pm

    Hi Mike,

    Thanks for your multiple comments. Good to hear that you are managing your post-operative care well. I wouldn’t worry too much about a sense of fullness at this time. It is early after your revision and there is much more to go in terms of skin contraction.

    It sounds like your surgeon is on top of your healing and doing what he can to get you the optimal result. Some surgeons do not believe in taping. In our experience, it will not change the final result but does help make our patients feel more comfortable with their noses in the first month or two after surgery. You should look forward to what I hope will be a great result.

  3. K August 4th, 2010 4:03 pm

    Similar to Mike, I have tent-like ‘squishy tissue’ to either side of the lower part of my nose, creating a triangular appearance. I can push down on it and feel that it is not adhering to the frame beneath it, as though there’s dead space- but I’m more than 2 years post-op. (I did have osteotomies.) Do you have any thoughts on having steroid shots this far out, or to that spot in particular? My surgeon isn’t terribly forthcoming and I’d greatly appreciate any second opinion.
    Thanks so much, either way.

  4. admin August 5th, 2010 10:40 am

    Hey K,

    It really depends on your particular skin characteristics. There are patients who may benefit from steroid injections at your stage, however, they are generally not as helpful as in the first 6 months to a year after surgery. Still, skin and soft tissue continue to remodel even 2 to 3 years after surgery and it might be worth seeing someone for an in-person opinion on this. Feel free to send us some pics if you like on our main site http://www.beverlyhillsprofiles.com.

  5. K August 8th, 2010 7:22 pm

    Thank you for the advice-I might indeed go ahead with photos on the site-thanks for mentioning it. Appreciated.

  6. Manaz August 10th, 2010 9:52 pm

    The steroid shot, great!
    The tape, still wear it !
    These doctors, I love them!
    The compliments, still coming!
    The doubts, all gone!
    My nose is beautifull!!

  7. Sara August 16th, 2010 9:36 am

    Hi: I had a nose reconstruction a year ago, with rib. I am still swollen. Do you think I could benefit from a steroid shot at this stage? Also, when do you think I will see my final results — waiting is tough!

  8. admin August 16th, 2010 4:32 pm

    Hi Sara,

    We know…waiting is the hardest part of rhinoplasty! But, you should hopefully be seeing noticeable improvements every few months. You might benefit from a steroid shot, though it is hard to say without examining you. Everyone heals differently depending on skin thickness and the degree and type of work performed on your nose. Feel free to upload some photos on our Contact page at our main site http://www.beverlyhillsprofiles.com/contact-us. These are kept entirely confidential. We may be able to give you a better idea of where you stand at that point. All the best.

  9. Corrine August 21st, 2010 7:23 pm

    Hello!

    I had rhinoplasty on August 3rd of this year to get rid of a hump on the bridge of my nose and reduce the length slight at the tip. When the cast came off my nose was awesome! No hump! But after a few days, I noticed the hump returning. It is slightly bruised across the bridge area still ( gets worse it seems by the end of day?!) . I am worried, the bump is back for good. I am hoping it’s just swelling that will go away and leave my nose looking straight the way it did when the cast came off. I haven’t taken any steroids just instructed to massage it.

  10. admin August 24th, 2010 2:15 pm

    Hi Corrine,

    If your nose looked great when the cast came off, you are probably dealing with swelling. Once the pressure comes off, the skin is allowed to swell a little. If you press down on the apparent bump, the skin should feel soft and spongy, and you should see it flatten out temporarily again.

    The race is to make sure that your skin can shrink and tighten down again before any scar tissue is allowed to build in the area. In most cases, gentle massage or taping the skin will help it to settle faster. I would follow the advice of your surgeon and go back for another visit if you are concerned about your progress. I hope you get a fantastic result.

  11. Sofia August 26th, 2010 6:40 am

    Hello,
    I had 6.5 months ago make changes to my bridge (reduce height) and tip (refine, shorten, slightly raise “droop”). I am very happy with the bridge, however, I still have a considerable amount of swelling and stiffness all around the tip, and the tip is still too upturned (as a result of swelling?). I had a small steriod injection in the supra tip at 5 months and within 4 weeks the swelling came down. However, the sides of the tip, and the columella are still swollen, I can (but no one else can) see where the steroid was injected because it pretty much only came down in that general area.

    I have another appointment for follow up in a week. My question is, are there other sites other than the supratip that steroid can be injected to reduce the swelling? For example, the sides of the tip? And also, will a steroid injection in the columella be helpful in allowing the tip to further “drop”?

    As an FYI, I am 100% Greek, and have the typical medditerean olive, slightly oily skin which gets very dark in the summer. I do know skin thickness has an effect on the recovery and the use of steroids.

    Any advice and information about steroid injections, sites, and results would be very very useful to me! I’d like to go to my next appointment loaded with info to discuss with my surgeon (who I am very very happy with – just getting alittle impatient with the swelling).

    Thanks!!!

  12. admin August 26th, 2010 10:16 pm

    Hey Sofia,

    Don’t get discouraged. It sounds like things are progressing well so far. We tend to reserve steroid injection for the supratip where skin is at its thickest. Injections can be done at the sides of the supratip area but should be done with care to avoid temporary thinning or indentation.

    We do not inject steroids in the columella as the skin here is relatively thin. Steroids will not help the tip to drop anyways. That is something that depends more on what was done during surgery and is a function of time.

    If you have thicker, oily/sebaceous skin and are generally happy at 6 months, you should expect to see continued improvement over the next 6 months to a year.
    Good luck.

  13. Steven September 14th, 2010 2:59 am

    Hi, last week I had some steriod shots on the 10th September 2010, to attempt to reduce the swelling that was remaining to the tip of my nose.
    Now last Friday, (the date of my steroid injections), was almost 2 years after my rhinoplasty operation, dating back to the 19th September 2008.
    The problem that I had come across since last Friday, was that my surgeon had last week told me to to moisturise and to then massage the tip of my nose area, (even after steroids shots).
    And he had encouraged for me to try and squeeze out the remainder of the swelling within the tip of the nose area (after applying a moisturiser of course), in a vigorous manner. But I had done this technique to which he had instructed for me to do for only 3 days. And the tip of my nose area has swollen.
    To which I hope is only temporary.
    And I feel that a gentle circular motion massage to the tip area of my nose would be far more desired now.
    As his suggested technique was far too ferocious.
    As I want to eliminate the swelling once and for all and to not encourage any further swelling to settle in.
    Have you any advice that you could give me for the meantime?
    As my surgeon did say that after cortison shots, it can take upto 3 months for the swelling to reduce itself.
    Many thanks and I would be so grateful if you could help me.

  14. admin September 18th, 2010 11:02 am

    Hello Steven,

    You may want to double check with your surgeon to clarify his intent. Gentle massage immediately after a steroid injection may help to distribute the medication. We do not advise vigorous rubbing as doing that anywhere on the skin will often cause some temporary irritation and swelling. We do advise some gentle pressure once or twice a day for a minute or so when there is persistent or asymmetric swelling. This is not likely to help much two years after surgery although steroid can sometimes still have an effect.

  15. tracy September 28th, 2010 9:47 am

    I had rhinoplasty/septal repair 1 year 5 months ago. In the middle of my healing I took a soccer ball directly to the nose which caused me a great deal of swelling. We delayed my 1 year due to this ( I did see my surgeon following the 2nd injury) I saw him yesterday which made it 1 year and 5 months and we did steroid injections on both sides of the bridge. Some of the swelling is soft at the tip and harder on the sides of the bridge. Do you think these will help? I am quite swollen post injection; how long will this last? How long will it take til I see a difference from the injection if any?

  16. admin September 28th, 2010 11:07 am

    Hi Tracy,

    Hopefully, your injury shouldn’t set you back too much. Post-injection swelling shouldn’t last more than a day or so. We find that it takes about 3 to 4 weeks to start noticing the effect of a steroid injection. This can be a little shorter or a little longer for some patients.

  17. Sara September 29th, 2010 8:15 pm

    Hi,
    Me again, 13 mos. post rib reconstruction. I was wondering if you could elucidate the difference between normal swelling and hematomas. I had one black eye at cast off and still have VERY asymetric swelling on that side with a slight black and blue effect on one side of my nose. Could blood be trapped there? It’s been going down VERY slowly too. What would be the treatment, if any? MORE time? Thanks so much!!!

  18. admin September 30th, 2010 1:16 pm

    Hi Sara,

    Rarely, when there is significant bruising under the eye, some residual pigment from the bruise can ‘stain’ the skin. This can take many months to go away and can sometimes be treated with a skin lightening agent to help it resolve faster. After 13 months, any major asymmetry can’t really be attributed to the original swelling any longer. You should visit your surgeon or feel free to send us some photos and we can arrange a consultation in-person or via skype.

  19. Allen October 2nd, 2010 11:01 am

    I recently got rhinoplasty (revision) and before I did not have a hump on my nose. Now it is over 2 weeks and the swelling has gone down and to my fear a hump has appeared!! My doctor took me not to worry that a few steroid shots show do the trick, should I believe him?

  20. admin October 3rd, 2010 8:42 am

    Hi Allen,

    Not to worry. It is not uncommon for there to be some swelling over the bridge soon after rhinoplasty that may appear as a small hump. This will usually resolve on its own without further intervention. Be wary of too many steroid shots high on the bridge as the skin is thinner in this area and there is a small chance of causing a small temporary depression there. Best of luck.

  21. Sara October 4th, 2010 5:06 am

    Also, would steroids help a hematoma? What about hyaluronidase?

  22. admin October 4th, 2010 8:46 am

    Recognizing and treating the hematoma by early drainage or aspiration is the best treatment for a hematoma. A true hematoma in the nose is rare. If it does happen, there can sometimes be some overactive inflammation as it is healing which may benefit from steroid injection over time. We do not generally use hyaluronidase in the nose since this medication can break down surrounding normal tissue and cause some temporary apparent skin thinning or depression.

  23. Steven October 6th, 2010 3:08 am

    Hi again and thankyou for your reply to my post :)
    And in reply to your post, my surgeons original intention for me to massage in a vigorous manner, was that he had felt that with me doing this, would help to break down the swelling even more so.
    Although I was not too sure of this technique, as steroid shots of Cortisone should over time serve it’s purpose.
    I have now however, stopped massaging in a vigorous manner, to how he had advised to, as a lot of swelling was beginning to set in. And the tip of my nose was becoming very sensitive and red in color, to which was an obvious irritation.
    Although now I am gently moisturing the tip area with Bio Oil in gentle circular motions, to help keep it moisturised and to not irritate it in the slightest. And now the swelling seems to be subsiding.

  24. admin October 7th, 2010 6:59 pm

    Hi Steven,

    Glad to hear it’s getting better! All the best.

  25. Holly October 8th, 2010 7:40 am

    Your website is amazing – thank you for all of the great information!

    I had a primary rhinoplasty ten weeks ago. I love the bridge of my nose, but my concern is my columela which is “hanging” to where you can see the redder skin inside my nose and I hate it…It did not hang before at all. I am in my 40′s and have thicker skin. What are the chances that this columela problem is swelling after 10 weeks? I am over 6000 miles from my own surgeon so I went to a new doctor today in Shanghai (I am from the US but work in China) and he said it could be either swelling or something with the way the incision was closed (it was an open rhino) Anyway, I had a steroid injection today. I notice the skin on my nose is very pale now. Will it really take weeks to see the results? If this injection helps, should I get another one? How long apart are they usually spaced? He (this new doctor) also said that if the columela is still “hanging” around 2 months from now, he could do a minor surgical procedure to raise it up. Does that sound right to you? I can see what he means about how it was closed. Where the incision was is where it poofs out the most, almost in a little point. Also, on the inside around the incision, there seems to be a lot of scar tissue.

    Any advice would be very helpful. Thank you!

  26. admin October 9th, 2010 7:04 pm

    Hi Holly,

    Sorry for the delay. We usually space steroid injections about 6-8 weeks apart to get a sense of what kind of progress we are making. It is important to use steroids in small doses and have it placed in the tissues deep to the skin. Otherwise, it can cause a small depression that fortunately almost always resolves in time. An apparent fullness in the columella can sometimes be from swelling and sometimes is a result of a particular technique that was used. The best person to talk to in this situation is your original surgeon. See if you can set up a skype or telephone visit and send some pics in advance. A lot can be done these days even thousands of miles away. Good luck.

  27. Sara October 10th, 2010 1:25 pm

    I am not sure what to do. I have been very confused as to what what going on, so researched what the long, bruised lump could be and concluded I must have bled too much, though my doctor has not said this. It’s frustrating that I am being told to wait and wait with no explanation as to what is causing this. It was never aspirated (or referred to as a hematoma), so at this point not sure what to do. Thanks for your help though….

  28. Ali McMahon October 12th, 2010 7:56 am

    Thanks so much for the opportunity to ask questions! It’s really helpful.

    I had a revision rhinoplasty 4 months ago to correct a few deformities I was left with after my first operation. My nose is beginning to take shape under the swelling (thankfully!) with many issues improved but I still have great difficulty breathing.

    This was something I had high hopes would be resolved through the second op. Do you think at this point I should resign myself to operation number 3 or is it still possible for it to improve?

    I’d really appreciate your opinion.

    Thanks a mil,

    Ali

  29. admin October 12th, 2010 2:08 pm

    Hi Ali,

    Don’t lose hope. Four months is still early after a revision where there were multiple issues addressed. Your breathing may still improve as the swelling settles. Talk to your surgeon and get a sense of what you can expect based on what was done to deal with breathing concerns. An honest surgeon will tell you if his/her attempts at correction were successful or not.

  30. Cass October 12th, 2010 3:38 pm

    Hi there, I had revision rhinoplasty two weeks ago and my PS inserted exteneded spreader grafts in my nose to lengthen it. I have alot of swelling now, but its polly-beak in shape which worries me. Would steroid injections helps to get rid of the fullness/roundness on the supratip which is causing the beak like effect?
    Thanks

  31. admin October 13th, 2010 7:12 pm

    Hi Cass,

    It is not unexpected for there to be swelling above the tip in a case where extended spreader grafts were used. Supratip fullness generally improves with time but steroids may help. Only your surgeon can tell you for sure. Bring it up at your next visit.

  32. CS October 14th, 2010 5:04 am

    Dear Dr’s S & L:

    Sorry to add to the big list of questions, but I wanted to ask; I am two years out from a very bad revision that involved lots of grafting, and I currently have an extremely unsymmetrical, bulbous, inflamed looking nose. To help keep a great mindset about it though, I do have to wear make-up on the nose to both hide the redness and to contour some of the bulbous or dented areas into looking more fitting for my face. The problem that is most severe, however, is a very hard pollybeak that keeps getting bigger, going straight down from the middle nasal bridge portion to tip point. It only bothers me slightly from the side, but from the front, it actually creates a very extreme shine in my nasal skin, an extremely leathery appearence where the bump is and this shine both looks very ugly and it gets pointed out by so many people; it truly isn’t oily skin at all, it’s a very hard, cartilage-feeling bump that keeps getting more pronounced and extremely distracting in all types of lighting. Specifically, the problem seems to be from my first primary surgery, where the doctor sutured my tip and bridge too tightly, which is what seemed to cause the protruding cartilage is his words.

    Thing is, while I know a third surgery is in my future, it seems as though if this pollybeak’s shine was fixed by minimal, evasive techniques (steroid shot? needle rasping? something else?), that it would truly help out my mindset so much and help my nose at least not be so “distracting” while I wait to have a full corrective procedure one day. At least the rest of my nasal contour problems can be comfortably illusioned with make-up techniques, but this bumped shine problem simply goes beyond that; it’s to the point that shine-reducing make-up doesn’t work in the least; I feel as though it really is a structure problem.

    If there’s any sort of advice you could give on what may be done, wether a evasive procedure may help me, or if I would be better to get a full revision rhinoplasty *also a financial concern right now* it would be great!

  33. admin October 19th, 2010 7:20 pm

    Hey CS,

    Sorry to hear you are experiencing so many problems from your previous nasal surgeries. It is true that a depression or concavity is easier to conceal with makeup or filler than is a convexity or ‘bump’ in the nasal contour. The ‘shine’ you are describing can sometimes be seen in swollen skin, however it is possible that the skin itself has been thinned out or altered from previous surgery. Even then, it can often be helped. With the other issues you have with your nose (bulbosity, indentations, etc.), it sounds like you will be best off considering another revision to deal with all of these. In the meantime, there is nothing we can easily suggest without a consultation or photos. Feel free to send some pics.

  34. admin October 19th, 2010 8:27 pm

    To All,

    We are amazed at how much interest this post has generated and we are moved by how many of you are troubled and would like answers to your healing questions and concerns. While we would love to answer each of you, we cannot make specific recommendations or give medical advice over the internet without photos or an examination of your nose. In the early months after surgery, your surgeon is in the best position to answer specific questions as he or she knows what was done and can explain how that fits with the surgical goals and expected recovery. If you are not getting the answers you need and continue to be unsatisfied with your progress as time goes on, we would be happy to arrange an in-person or skype consultation to answer your questions more fully. We hope you continue to find this blog helpful as a resource for your rhinoplasty questions. All the best.

  35. angelique November 9th, 2010 2:30 pm

    Hello
    I’m from Mexico, I had nose surgery almost 6 months ago to fix my nasal bone that was crooked and was really giving me some problem to breath, as soon as I took the cast off couple weeks after the surgery I was terrified, it looked really crooked, the nostrils uneven and from the sides one side looked ok compared to the other one which was super swollen, it has improved a lot, but it still looks deformed, i guess its the one side that is still very swollen and not defined like the other. My surgeon recommended filling the one side that looks fine to make it even which I completately said no to because the puffy side looks horrible! he said he would never use steroid shots on any of his patients ( dont know why) so I just dont trust him anymore. Another doctor suggested new surgery and a third one the steroid injections. Given your experience what do you guys suggest.. another surgery.. the injections..or just wait? is there any chance I could send some pictures.. I would appreciate it.. I’m desperate and psychological traumatized.. ppl said its not THAT bad.. but idk.. I dont even wanna leave my house =(

  36. Suezan January 11th, 2011 1:15 pm

    Hello,
    I had recently undergone my third revision rhinoplasty for a droopy and crooked nose with a very sharp piece of cartilage pointed out at the very tip of my nose. This sharp pointed piece of catilage at my tip is horrible and feels sharp….my doctor dismisses my concern ..is there something I can do? I push it down but I’m afraid that I will cause the nose to droop if I keep pushing on it. I’m afraid of steroids to be used since I heard alot of side effects such as a droopy nose..is there anything I can do or my doc can do

  37. admin February 2nd, 2011 11:21 am

    Hi Suezan,

    We would not suggest pushing on a palpable edge of cartilage as it is not likely to help the situation. You are best off in the early stages after surgery to address your concerns with your surgeon. He or she should be able to answer you regarding what you are feeling or seeing, and what can be expected over time. If, after some further healing, you are not seeing any improvement, that is the best time to seek out further opinions about possible revision if needed. I hope you can re-discover some good communication with your surgeon in the meantime.

  38. Sophia March 19th, 2011 6:17 pm

    Hi I underwent revision open rhinoplasty in New York with a Reputable Surgeon just 16 days ago. I originally had a flat african Carribean nose. However, my bridge now appears too high. Will this change you think or will it reduce once the swelling has subsided?

  39. admin March 21st, 2011 9:43 am

    Hi Sophia,

    Thanks for your question. After just 16 days, there is certainly some swelling that will continue to settle. We sometimes find, when it comes to rhinoplasty in people of African descent, that there is too much emphasis placed on bridge augmentation and not enough placed on creating tip definition. However, we would advise talking to your surgeon to review what was done to raise your bridge and what you can expect with regard to final bridge height once swelling subsides. I hope you are pleased with your eventual result.

  40. Jason March 22nd, 2011 12:47 pm

    I have too long a story to tell. Basically a form of Sluder’s syndrome and pain/headache from lower portion of the anterior ethmoid nerve. But to keep it short, I had a 3rd surgery to correct nasal contact points and anatomy in December of 2010 to try and relieve the pain and headache I’ve experienced for the past 5 years. How long should I wait for these areas to heal? Would injected steroids be something I should speak with my surgeon about?

  41. admin March 22nd, 2011 10:01 pm

    Hello Jason,

    I’m sorry to hear you’re still having trouble with your headaches. Relief of contact points responsible for Sluder’s syndrome should be immediate after surgery. While there may still be some swelling, your surgeon should be able to tell you if the nasal obstruction and contact has been resolved. All the best for finally obtaining relief.

  42. gina April 12th, 2011 6:33 pm

    its been sixs weeks after my rhinoplasty and i was swollen after he took my cast off. Swelling is not as bad but still there but when i look at my profile i get nervous cause it seems alittle high still how long before that goes down

  43. admin April 14th, 2011 10:31 am

    Hi Gina,

    The swelling over the bridge will slowly go down over several months. If the tip seems lifted, it will usually settle down a little, but it is best to talk to your surgeon about what was done as this will affect the eventual position of the tip. All the best,

  44. Will April 22nd, 2011 9:13 pm

    Hi, I’m african american and my rhinoplasty consisted of fixing a lack of tip support due to an injury when I was about 12. They gave the tip support, and shaved the sides. It’s been 19 months, a lot of the swelling has gone down but there’s residual swelling (tip swelling and bridge swelling) the swelling is mostly evident when I scrunch my nose, the pores seem to enlarge. Maybe 20% that hasn’t changed at all in the last 6 months. Would steroids help at this point? Or should I just wait for the full 24 months and see? Thanks

  45. admin April 25th, 2011 9:39 am

    Hi Will,

    It’s hard to know without examining your nose. We would advise paying a visit to your surgeon and comparing standardized photos. If you truly don’t see any change over many months, you may not see a whole lot more. Steroids may not be very helpful at this stage but it doesn’t hurt to ask. The question for you will be whether you are satisfied with the result or is it worth it to you to pursue anything further? All the best,

  46. marg May 9th, 2011 4:58 am

    Hello,
    Your blog is very helpful! I had a rhinoplasty 2 years back to get rid of a bump and reduce the size of my tip and improve my droop.

    2 years post op and there is swelling around my tip and significant columella swelling that looks droopy(my surgeon said he removed some alar cartilage and lifted the tip with some septal cartilage) I am contemplating steroid shots but am very doubtful at this point about being 2 years post op. Will they help so late and will steroid shots be helpful in reducing the columella swelling? I am now scared about the steroids shots increasing the swelling that may not go away!

    Also, the surgeon says that I still have edema in my tip due to lymphatic channel obstruction and the nature of my skin which is relatively thicker and that I have overactive sebaceous glands. How long do the lymph channels take to recanalize and is there still hope for my nose to get smaller/more defined as no grafts were put in(the tip looks bigger than before due to the swelling)

    thanks!

  47. admin May 9th, 2011 10:40 am

    Hi Marg,

    Sorry to hear you have not gotten the definition you wanted from surgery. Sometimes, you can see continuing changes over the first few years after surgery depending on skin thickness. But, gaining definition in thick skin relies on making sure that the cartilage structure underneath is strong with good contour. For this reason, you may find that steroid injections are unlikely to make a big difference at this stage. Feel free to send us photos via our main website doctor@bhprofiles.com and we may be able to be more specific.

  48. Brittany May 29th, 2011 1:29 pm

    Hello…
    I had rhinoplasty done almost 3 weeks ago… The results of my nose look pretty good and over all I am happy with it, however I had the bridge taken down and the tip smaller… the tip looks great but there is still a little bump on my bridge… my doctor says its too early to tell if it is just swelling or not but its really making me nervous :( I want the bridge to go down because its making me feel very self conscious and I really hope i dont have to result to revision rhinoplasty… any advice? do you think it is just swelling?? HELP!!!

  49. admin May 31st, 2011 9:44 am

    Hi Brittany,

    It’s pretty common to have some residual fullness due to swelling over the area where the bump had been. Don’t be too nervous about it at this point. Follow the advice of your surgeon and you should find it settles down over time.

  50. Nicole July 22nd, 2011 7:08 am

    I had surgery almost 6 months ago and about a month after my cast came off a bump formed and has not gone away. On my last visit my dr examined my nose and was like it looks great, and that he’d be OK if the knot didn’t go away. Then he even stated that most swelling in that area was gone and it probably wouldn’t go away. The problem is I’m not ok with that. The hump is at the top left of the bridge. Do you have any advice?

  51. admin July 22nd, 2011 6:07 pm

    Hi Nicole,

    It is uncommon but, sometimes as the bone is healing, a small inflammatory bump called a callus can form over the bridge that usually will settle down on its own over time. Sometimes, a little steroid shot will help. Rarely, a small revision is needed at 9-12 months to resolve this. If your surgeon is not acknowledging your concern, you might discuss it with him again or consider getting another opinion.

  52. mike July 23rd, 2011 9:05 pm

    2.5 months post op. I have a bump on the bridge of my nose that wasn’t there before surgery, asked my doctor about shots he said he wants to wait and see how it settles. when is it two late for shots to help with swelling. would tape help with this.

  53. admin July 25th, 2011 2:16 pm

    Hi Mike,

    We find steroid injections most helpful in the first year after surgery, and especially in the first six months. When to start them is a personal choice for each surgeon and may depend also on a particular patient’s skin thickness and what was done during surgery. Taping will help reduce swelling temporarily but will not influence the final result. Good luck with your healing.

  54. mike July 25th, 2011 9:03 pm

    Thanks for the response. will taking workout supplements like CREATINE affect the healing process?

  55. Mark August 18th, 2011 5:13 am

    Hello there,

    I want your advice about my case,
    On 2007 I had rhinoplasty, from the front view my nose was straigh, but from the side view it wasn’t, so the doctor had that fixed, post op i was completely satisfied with my nose, but later i noticed it getting crooked (front view).
    It is so crooked, that one side looks depressed and nice, and the other looks swollen, it remained the same for years..
    On 2010 I decided to go for a revision, this time I chose a good surgeon in Lebanon and I told him I only want him to make it straight..
    Again, right post op my nose got straight and nice, but like one month later it got crooked from the same side.

    It would be very visible when taking pictures with flash light, very crooked, and i am devistated, it looks ugly in pictures, even if you look at it from specific angles it would look crooked.

    Sometimes I massage it, and I feel like there is difference in its shape after massaging, like it gets more straight.. so I dont know why is this happening?
    is it the doctors’ fault? is it scar tissue and i need steroid injection?

    thank you for your help

  56. admin August 19th, 2011 9:31 am

    Dear Mark,

    Without specifics of your case, it is impossible to tell you anything meaningful about why your nose is crooked. It is often the case that the nose may look straighter for a short time after revision because of swelling but, as the swelling goes down, you may see crookedness that either returned or was never fully corrected. If you are able to send photos to our main site via the Contact Us page, we’d be happy to arrange some time to talk about your situation.

  57. Damion August 26th, 2011 8:16 am

    I had a revision rhinoplasty 6 weeks ago, now my nose is extremely oily/greasy and is more swollen since the cast came off. I had liked the nose immediately when the cast came off but now its more swollen to the point that it looks bigger than my old nose and the swelling is not going down, For the oily skin i have started using a face cleanser that moisturizes the skin and exfoliant for the pores and blackheads. Is there many harm in using these products? How can you explain the swelling problem? The entire nose is swollen (both bridge and tip)

  58. admin August 27th, 2011 11:26 am

    Hi Damion,

    It’s pretty common for swelling to get worse for a time after the cast comes off before it starts to improve significantly. You should talk to your surgeon about what products you should or should not use on your nose. Moisturizers and cleansers should be fine but you may want to avoid any significant exfoliants as the nasal skin can be sensitive at this stage. All the best,

  59. mike August 29th, 2011 9:05 pm

    My doctor gave me a steriod shot on the bridge where the hump was. could tell a big difference in just days. you guys also suggested tapeing, is this medical tape across the bridge or a special kind of tape?

  60. admin August 30th, 2011 10:58 am

    Hi Mike,

    We use Micropore paper tape in our practice, but any medical paper tape, available over-the-counter in most drug stores, will do just fine. The areas that benefit most from tape are the area immediately above the tip and over the mid-bridge, if a hump was taken down.

    All the best.

  61. Jenny October 5th, 2011 2:15 am

    I didn’t have rhinoplasty but I had a premaxillary silicone 4mm small implant put in through my nose on sep 2nd aswell as submalar cheek implants I had all the implants removed through the mouth on sep 28. I had them removed because my nose looked like a pig snout. The swelling in the
    Cheek area has reduced alot but my nose is still swollen and wide with upturned nostrils that are much wider than before. I had no idea this implant would change my nose I thought it added fullness in the area under the nose and above the upper lip. I can not find any information on it.. When can I expect to see my pre op nose I am very distressed and why is my nose different?

  62. admin October 5th, 2011 8:55 am

    Hi Jenny,

    Sorry to hear you are distressed about your current appearance. Since you just had the implants removed a week ago, most likely you are seeing a lot of residual swelling at the base of the nose. This can make the angle of the tip appear upturned and will hopefully settle down for you soon. We’d recommend talking to your surgeon to get a sense of what is happening and what you can expect as a timeline for healing.

    All the best,

  63. Jenny October 5th, 2011 11:59 am

    Thankyou! Yes I am trying to get in touch with my surgeon that removed the implants, I was an out of town patient. I was told that because the nasal spine and pyriform aperture were disrupted from the implant that it could leave the nostrils slightly wider than before…and yes I am really hoping that this is not permanent and is only caused by the swelling, but when reading about rhinoplasty swelling it seems to last a very long time. The implant went up the sides of the nose and it does feel tight there so is it likely that is what is causing nose and nostrils to be wider? Thankyou for your input I realise this is not a rhinoplasty case but it had turned out to have effected my nose.

  64. Joe October 9th, 2011 2:48 pm

    How many kenalog injections at most do you usually give your patients after surgery? I received two after my first surgery and another two over the past few months after my revision. Every time they provided great relief for the swelling but then the swelling came back. My doctor this week told me he doesn’t want to give me any more because of the potential risks.

    I’m 4 months post revision, and I recently started cutting back on my sodium tremendously and wearing sunscreen with zinc oxide. Is it possible that the damage has already been done if I’ve been on a high sodium diet prior to now? Only recently did I learn that excessive swelling from things like sodium may lead to more scar tissue. I’ve been massaging the nose daily in hopes of getting rid of any scar tissue that may be building up. Is there anything else I can do? Thanks in advance for your advice! Your site is very helpful

  65. admin October 9th, 2011 3:38 pm

    Hi Joe,

    There is no prescribed number of kenalog injections that is right for any one patient. Ultimately, it is a judgment call by your surgeon to weigh the potential benefits against the small possibility of thinning the skin or unwanted effects. Avoiding a high sodium diet can help with reducing swelling but I’m not aware of it having any long-term effect on scar tissue. You may wish to discuss tissue massage with your surgeon. Like anything, what is good in moderation can sometimes be too much if overdone. All the best.

  66. Sophie October 10th, 2011 4:17 am

    I had rhinoplasty surgery exactly 3 years ago. After about 2 weeks of the surgery my nose seemed to be getting the shape I desired. However, for some reason my nose started to swell and I have been told that I have scar tissue which has resulted in a bigger bottom part (which has drooped slightly and slightly humped bridge). I was wondering what my options were. The doctor I usualy see has said that I would need steroid injections – is that not too late to get rid of the scar tissue and make my nose go back to how it was after two weeks, i.e. get rid of the hump, swelling and drooping. Btw, if it helps, I did bump my nose a few times in the weeks after my surgery (my doctor has said that was unlikely to have impacked anything).

  67. admin October 10th, 2011 3:45 pm

    Hello Sophie and thanks for your question. Sometimes steroid injections can have some benefit even at your stage after surgery but we find that the effects are generally less predictable and less helpful overall much beyond a year after surgery. Still, there is no harm in trying if your doctor thinks it will help. We hope the injections work but, if not, you may wish to discuss options for revision that will help prevent this problem in the future. Good luck.

  68. Michelle October 12th, 2011 8:25 pm

    After my 1st rhinoplasty, I developed a callous bump on the bridge of my nose. So my Doctor had to perform a Revision Rhinoplasty to rasp or file down my callous hard bump. 2 weeks after my Revision Surgery, I died a thousand deaths when I felt another callous bump had developed not in the same area as the first one, but a little higher up on the bridge and to the left. Can you tell me why this happened again and more importantly, my Doctor said he could use an 18 gauge need with just local and file the callous down without even lifting the skin or having surgery! Is this too good to be true? Will it create another callous or will it be successful? Please answer my questions as I have been very depressed about this outcome thus far. Thank you so much and God bless you both!!!

  69. Michelle October 12th, 2011 8:35 pm

    I meant to say My Doctor said he could use an 18 gauge Needle to file or rasp my callous bump down. Have you ever done this before and was it successful? Is there a lot of inflammation from it and will my skin or outer area be damaged or flawed afterwards…? Is it likely that I would develop another callous bump as a result of this type of stimulation to the bone or is that callous that I developed only due to my having had an “Open” rhinoplasty procedure…? Would a steroid shot work? Or is it possible that the callous could go away on its own? Because my 1st callous bump lasted 10 months and didn’t go away, so I had my Revision but if I had waited longer, could it have gone away on its own…? Thank you so much for answering my questions! I truly appreciate your time and am eternally grateful… ;)

  70. admin October 13th, 2011 9:35 am

    Hi Michelle,

    Callous formation happens from irritation and inflammation of the nasal bone or, more properly, the lining over the bone called the periosteum that happens when the bone is shaved. The body responds to this by wanting to lay down new bone to ‘heal’ it just like after a fracture. It does not matter if this was done through an open or closed approach. In most people, this inflammatory process is relatively mild and short-lived. In a small percentage of people, this process is very vigorous and the resultant bump or callous can last for a long time. Usually, it will settle on its own but may take a year or longer to settle completely. Some surgeons do like the needle shave procedure but it is not something we do very often. We have found that steroid shots do help in resolving the problem more quickly. You might ask your surgeon about whether he would recommend it. All the best,

  71. Michelle October 16th, 2011 6:37 pm

    Hello again Gracious Doctors,

    I have one more question to harass you with… In your past reply, you mentioned that in regards to my bony callus overgrowth “We have found that steroid shots do help in resolving the problem more quickly”. So ~ I was wondering if you could be so kind as to tell me how many and how often should I do the steroid shots…? Because I went to my Doctor and asked him to give me a steroid shot into the callus and he did! He said it was just a tiny amount though. And I believe it may be slowly diminishing, but it’s too soon to tell. Although I did notice the area may have hypo-pigmented a bit, but not enough to bother me… Should I continue with another shot or leave it alone since I hypo-pigmented a bit…? I just want to know your protocol for handling this kind of situation… Also ~ when do you typically begin to do steroid shots into the “tip” area…? I cannot express to you both how grateful I am for your time, energy and expertise. You both are truly God~send! ;)

  72. Emmanuel October 18th, 2011 5:58 pm

    Hello Doctors,

    I had rhinoplasty on August 19th 2011. My nose looks fine but the bruising under my right eye has not gone away. It basically looks like a black eye. I have an appointment set but wanted to know if this is normal? I’m very worried it won’t go away…

  73. admin October 19th, 2011 9:18 am

    Hi Emmanuel,

    Glad to hear your nose is looking good and sorry to hear about the black eye. A deep bruise can rarely take a while longer to go away than you would like. Some of the breakdown products of a bruise can deposit in the skin and cause discoloration. In people with more deeply pigmented skin, the skin can also sometimes react to inflammation from surgery by creating more pigment under the eye. This will generally fade on its own, but you should talk to your surgeon about what can be down to speed it up. Sometimes, a bleaching cream can be helpful. Good luck.

  74. anitha October 20th, 2011 5:32 pm

    Hi Doctor,
    After my rhinoplasty, i see one side of my nose has swollen more than the other which i am hoping will go down in a few weeks or months. But my concern is more about the other side which is not swollen seems to have some dark skin on the nasal bridge on the side which casts a shadow that makes my centreing appear all the more twisted and uneven. will the dark clot/hematoma on the nasal bridge sides go away? it is soft tissue that has a darker appearance than rest of the skin on the nose…. and when i touch it, it feels like nothing is there under it..no bone or anything. when i touch the other side of the nasal bridge i can feel the bone underneath. iam so worried my nose looks bent and concave on this dark side. pls help.

  75. admin October 21st, 2011 1:15 pm

    Hi Anitha,

    I don’t know how far along after surgery you have come but, if surgery was fairly recent, it is best to talk to your surgeon directly regarding your concerns. It is possible the skin itself is just bruised and will improve with time. On the other hand, if bone was thinned out more on that side, you may be seeing a depression or shadow over the area. It is impossible to know without an exam. Hopefully, your surgeon will be able to give you a better understanding when you next meet. All the best.

  76. Sydney October 30th, 2011 9:20 pm

    Hi,
    I had rhinoplasty over 2 years ago to remove a bump and straighten my nose. I was not happy with the result so I had revision rhinoplasty 1 year and 4 months ago, and the surgeon told me she had removed a lot of scar tissue that had formed from the first surgery. I was happy with the result of the revision surgery after the cast was taken off and continued taping at night for several months, as I noticed swelling everyday, which got worse throughout the day. I stopped taping and since a few months ago have noticed the bump forming again, it feels harder than before, and I still notice a bruise over the bridge. I am afraid that scar tissue has formed again, and that the bump will not go down. Is this normal? or should i consider steroid shots? Thank you!

  77. admin October 31st, 2011 10:06 am

    Hi Sydney,

    It is hard to answer questions like this without a nasal examination to feel over your bridge and take a look at the skin. We would advise seeing your surgeon who may well consider a steroid shot. All the best,

  78. Jenny November 15th, 2011 6:11 am

    Hi I had the premaxillary implant put in through my nose and removed after 3 weeks, it has been 7 weeks since removal, my nose has been swollen for 10 weeks now, is it possible this swelling can turn into scar tissue?

  79. mike November 28th, 2011 3:15 pm

    I’m 7 months post op I still have a droppy tip. when I ask if he could up turn the tip like we talked about before surgery, he said no and would see me in May of next year. at this point do I ask another Dr. for help, I’ve heard of botox helping droppy tips. I don’t want to wait as long 6 months. will I see much more swelling go down from this point. Thanks.

  80. Kim December 28th, 2011 11:44 am

    Hi I had an open septoplasty oct.11 I’ve noticed that the skin on my nose looks different like bumpy almost and sweats more than usual …like little beads of sweat. I’m wondering if the bumpiness on my nose are my pores which seems to be enlarged and will it shrink back down and have a normal appearance.
    No one else seems to notice it but I do..it almost looks like pitting from acne scars but very small. It also makes my makeup not apply so well.
    It really bothers me …

  81. admin December 28th, 2011 4:12 pm

    Hi Kim,

    Some patients do notice that their skin seems to be more oily or sensitive for several months after rhinoplasty. This is all due to inflammation and should go back to normal as the skin contracts and heals.

    All the best,

  82. Anni January 15th, 2012 3:23 pm

    Hello doctors! Had I only found you before my procedures with another BH doctor! :( I am not happy with my results- it is 5.5 months after surgery.
    Nose is still extremely swollen (much larger than before).
    However there was also a suture that was on the top of the bridge of the nose after surgery. It came out, and I now have a scar (albeit is small, but sill was not there before).
    Is this normal?? Why would there be a suture on the outside bridge of the nose? Have you ever seen this before? I think my doctor should do a free fraxel laser treatment to try to get rid of it.

  83. admin January 16th, 2012 10:23 am

    Hi Anni,

    Sorry to hear you’re not happy at this point. It’s still early and hopefully your nose will settle to your liking. We and other surgeons occasionally place a suture through the skin in order to stabilize a graft over the bridge in the first week after surgery. I’ve not seen a suture leave a scar in that area. You should check with your surgeon to see why this was done and what can be done for the resultant scar. I hope you get the result you are looking for. Best,

  84. Adam March 20th, 2012 2:32 am

    I have a similar issue to that of Mark (Mark August 18th, 2011 5:13 am) For a few weeks after receiving reconstruction my nose was flawless, the way i always wanted it to be. Then to my surprise a pump/projection appeared on the left side of my nose. (this is horrific in pictures). A year after the surgery my doctor gave me an injection for calcification as he thought it would solve the issue. The injection did nothing. My doctor then gave me a few steroid injections. its been 3 years since the surgery and the bump is still on my nose?? i feel that my doctor incorrectly diagnosed me before both types of injections.

    I recently did my own research and i believe that the bump on the left of my nose is likely due to a uneven tip bossae which was a mistake caused by my doctor?? Reading different blogs, i came across many individuals who have gone through a similar situation. Their doctors left them hopeless/with no answers. Why are tip bossae problems not commonly discussed in the cosmetic medical community? why do our doctors resort to injections? this issue has damaged my confidence

  85. admin March 20th, 2012 4:12 pm

    Hi Adam,

    I am sorry to hear that you’re having issues with potential tip bossae. I doubt that your surgeon was trying to simply placate you. He was likely treating what he thought was scar tissue and hoping for improvement. That being said, you may well be correct about the bossae, but I’d advise being careful about making your own diagnosis. It is best to visit a revision rhinoplasty surgeon, if you haven’t already, to evaluate your nose and give you confirmation of your diagnosis along with an honest appraisal of what can be done to improve the situation. Tip bossae are not correctable with injections but they are often correctable with revision surgery in the hands of an experienced surgeon. Feel free to send us some photos on our main Contact Us page at http://www.beverlyhillsprofiles.com

  86. marie November 11th, 2012 11:05 pm

    I had rhinoplasty 7 yrs ago and still the right side of my nose at the very top, between my eyes swells severely every night when i am sleeping. I sleep on 3 pillows and even deal w neckpain. My dr put a spreadergraft on that side of my nose, can that be the cause of the swelling of the bones between my eyes? I can literally push hard and they push back in place but it leaves bruising. Please help! I want to cry. What could cause my nose to swell this much for 7 yrs and how is it that by pushing hard enough i can move the bones back? My dr doesnt know.

  87. admin November 12th, 2012 3:06 pm

    Hi Marie,

    Without examining your nose, it would be hard to tell what is causing persistent or recurrent swelling in this area. It is rare for the bones to be mobile or compressible that long after surgery. We have seen a rare case where a bit of mucosa or nasal lining tissue became entrapped during healing and caused recurrent swelling after rhinoplasty. This is something that your surgeon or another consulting surgeon could possibly evaluate. Without seeing you in person, it is hard to tell you anything more informative. All the best for a resolution.

  88. Crystal October 16th, 2014 6:26 pm

    Hi, I had open rhinoplasty Oct 7th to reduce a hump on my upper bridge, shorten tip projection, & rotate tip upwards as it hung low. My cast was removed Oct 14th and I am really pleased with everything already as it looks great despite the swelling. When I tilt my head backwards the bridge seems to be more to the right side and not centered? I’m not sure if I am seeing this right or if its possible, it was broken and moved inwards. It is very swollen so its hard to tell. Is this possible? have you heard or seen this before where the whole bridge sits more to one side then the other and isn’t centered?

  89. developer October 17th, 2014 9:40 am

    Hi Crystal,

    Thanks for writing. We’re happy to hear that you are pleased with your result so far. It’s possible that your surgeon broke and moved your nasal bones- only he or she can answer that for you. More likely, and this is something that exists in everyone, you have some existing facial asymmetry that is more noticeable to you now that you are looking so closely at your nose after surgery. There may be a significant swelling component to any asymmetry that you are seeing at this stage as well. I’d encourage you to raise this question with your surgeon at your next visit. Good luck and congratulations on your positive outcome!

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