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Injection Revision Rhinoplasty – But Not What You Think!

I happen to get several inquiries a week regarding possible injection rhinoplasty. Injection rhinoplasty is a term that was introduced years ago into the plastic surgery world to imply reshaping of the nose by injecting one of many different biocompatible materials. This primarily implied use of injectable fillers to reshape the nose – such as Restylane, Juvederm, Perlane, Radiesse, and Artefill. There is some controversy out there on the merits of injection rhinoplasty or lack thereof. But I wanted to post this plastic surgery blog entry on a different type of ‘injection rhinoplasty’ that is much less popular in the world of rhinoplasty and revision rhinoplasty. This involves the injection of a steroid solution, such as Kenalog, to reshape the nose. Over the years my San Diego rhinoplasty and revision rhinoplasty practice has grown increasingly larger to the point where we are considered one of the regional referral clinics for performing advanced, complex cosmetic nose reshaping surgery. Along the way, I have become quite comfortable using injectable steroids like Kenalog as an adjunct to surgical techniques used during rhinoplasty and revision rhinoplasty. The following case example of a San Diego revision rhinoplasty patient highlights the potential benefits of using steroid injections to help reshape the nose.

San Diego Revision Rhinoplasty Candidate

This male San Diego rhinoplasty patient presented to our office noting a moderate amount of scar tissue along his nasal bridge following prior nose job done in Los Angeles nearly 20 years ago by a different rhinoplasty surgeon. He had consulted with many rhinoplasty specialists over the years but was unable to find someone to reshape his nose in a non-invasive fashion. He finally consulted with us here in San Diego after learning of our vast experience in revision rhinoplasty surgery. During his revision rhinoplasty consultation, he was noted to have rather dense scar tissue that could be felt along the bridge region as seen in the adjacent photos. On his frontal view of the nose, you can see he had excess volume and fullness along the right side of his nose (white arrow). This contributed to asymmetry of his front view. On the side view, his nose had a ‘stepoff’ deformity (white arrow) – meaning the upper bridge was a different height than the remainder of his bridge. As you can, the upper portion was several millimeters higher than the middle portion of his bridge. His desire was to achieve more symmetry on frontal view and a straighter profile view. However, this particular patient was not interested in undergoing a formal revision rhinoplasty surgery to accomplish his goals.

Nasal Steroid Injections & Rhinoplasty

He specifically searched out our San Diego rhinoplasty practice online and discovered that I had extensive experience in managing noses using steroid injection. We had a lengthy conversation about his nose and decided this would be a reasonable option to help attain the desired cosmetic nose appearance. We started off with a modest amount and concentration of Kenalog injection into the nose. The injections were targeted to try and reduce the upper bridge and side wall of the nose. Going into this, the patient was fully aware that steroid injections typically involve a series of injections rather than just one treatment. As in many rhinoplasty and revision rhinoplasty patients, there was only a mild change that was seen after the first steroid injection into the nose. But after a series of steroid injections (spaced apart 6-8 weeks), we both began to see a real obvious change in the shape of his nose. Eventually we were able to attain the desired cosmetic nose shape and size. This can be appreciated in the following before and after ‘non-invasive’ revision rhinoplasty photos.

Before & After Injection ‘Revision’ Rhinoplasty

Technically speaking, he did undergo cosmetic nose reshaping or rhinoplasty, but not via a comlex surgical procedure. We were able to accomplish the following simply by injection rhinoplasty using steroid injections into the nose. As you can see, his nose is now more symmetric. In addition, the bridge height is now more uniform with a straighter profile compared to before. He is quite please with his revision rhinoplasty results and is even happier that this type of revision rhinoplasty outcome could be achieved without surgery!

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