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. 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.

  2. 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.

  3. 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.

  4. mike July 25th, 2011 9:03 pm

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

  5. 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

  6. 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.

  7. 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)

  8. 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,

  9. 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?

  10. 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.

  11. 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?

  12. 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,

  13. 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.

  14. 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

  15. 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.

  16. 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).

  17. 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.

  18. 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!!!

  19. 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… 😉

  20. 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,

  21. 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! 😉

  22. 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…

  23. 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.

  24. 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.

  25. 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.

  26. 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!

  27. 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,

  28. 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?

  29. 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.

  30. 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 …

  31. 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,

  32. 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.

  33. 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,

  34. 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

  35. 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

  36. 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.

  37. 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.

  38. 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?

  39. 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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