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Steroid Injections

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Steroid injections are a vital tool for any rhinoplasty specialist. When it comes to rhinoplasty, corticosteroids, also known as glucocorticoids, are used to reduce inflammation in the nasal tissues following nasal surgery. Corticosteroids can be taken orally or administered via an injection. Following a rhinoplasty, steroids can be injected directly into the nose to help reduce swelling and the development of scar tissue.1

Uses For Steroid Injections After Nasal Reshaping

There are several indications for steroid injections following rhinoplasty or revision rhinoplasty. Steroid injections are most commonly used to reduce swelling, prevent scar tissue from forming, or treat scar tissue that has already formed following nasal surgery.

Steroid Injections To Reduce Swelling After Rhinoplasty

Swelling is inevitable during any nasal surgery, but the degree of swelling (edema) is dependent on the type rhinoplasty performed, the extent of the surgical modifications to the tissues, and the patient’s skin type.

For most patients, the initial phase of swelling from a rhinoplasty procedure typically resolves naturally within 14 days of surgery. However, there is a subsequent phase of swelling that can continue for months or even years after a rhinoplasty procedure. It is this type of persistent swelling that Dr. Cangello can use steroid injections to target and eliminate following a rhinoplasty or revision rhinoplasty.

When indicated, steroid injections are used to accelerate the healing process. These injections allow patients to reach the desired nasal appearance sooner than the 6-12 months the natural healing process can take to achieve.

Steroid Injections To Prevent Scar Tissue After Rhinoplasty

Steroid injections can also be used to prevent scar tissue from developing following nasal surgery. Rhinoplasty patients that have moderately thick to very thick soft tissue are more prone to forming dense scar tissue between the bone or cartilage and the nasal skin.2 These patients tend to include the ethnic rhinoplasty population whose noses often display the moderately thick soft tissue that is predisposed to scarring in the supratip region, as well as other areas.

If this scarring proves to be excessive, it can prevent the nasal skin from shrinking or molding to the new shape of the underlying bone and/or cartilage. Subsequently, the nose will not be able to achieve the definition that would otherwise be possible. For these patients, a steroid injection placed strategically can prevent this type of unwanted scar tissue from forming. The obvious benefit is that the patient has the best possible chance of achieving the optimal refinement and rhinoplasty result.

Steroid Injections To Treat Scar Tissue After Rhinoplasty

Additionally, steroid injections can be used long after rhinoplasty and/or revision rhinoplasty to treat scar tissue in the nose that has already formed. For these patients, typically the same ethnic population noted above, scar tissue has developed and matured and is preventing the nose from conforming to optimal contours. Steroids can be injected to dissolve dense scar tissues allowing for refinement of the appearance of the nose.

Steroids Used In Rhinoplasty Procedures

Dr. Cangello can use a variety of steroids to reduce inflammation, depending on the patient and their needs. Dr. Cangello generally uses triamcinolone, also known by its brand name Kenalog. This synthetic corticosteroid is a potent steroid with a powerful anti-inflammatory effect.3

Timing Of Steroid Injections Following Nose Surgery

Following nasal surgery, the timing of steroid injections depends on several things. Some rhinoplasty surgeons prefer to administer steroid injections in the first 1-2 months following a rhinoplasty or revision rhinoplasty to prevent scar tissue from ever developing. However, most of the swelling seen in the nose during this time will ultimately resolve on its own. Additionally, some of the scar tissue formed during this period is good scar tissue that is integral to maintaining nasal structures.

While there are rhinoplasty cases where a steroid injection in the nose is indicated within the first 1-2 months, Dr. Cangello generally prefers to wait at least 3-4 months following nasal surgery before administering a steroid injection into the nose. By this time, most rhinoplasty patients are at the stage in the healing process where they are starting to see subtle refinements in the new contour of their nose. Steroid injections are beneficial at this time because they enhance and refine the nose’s new shape. It is also safer to inject steroids at this time, as it is less likely to inhibit the formation of good scar tissue.

Finally, steroid injections 3-4 months into the healing process can also treat established scar tissue, depending on the amount and concentration of the steroid used. For an experienced rhinoplasty expert like Dr. Cangello, steroid injections are an effective tool for further refining and enhancing the desired contour of the nose long after the formation of scar tissue has occurred.

Series of Steroid Injections

For many rhinoplasty and revision rhinoplasty patients, steroid injections are administered in a series of shots. While some patients only need one injection, Dr. Cangello often needs to administer several steroid injections over a period of time to achieve the patient’s desired result, waiting approximately 4-6 weeks in between each shot. Using this spaced approach, Dr. Cangello is able to shape the nose incrementally in parallel with the natural healing process.

Complications And Risks Associated With Steroid Injections

Steroid injections are considered a safe and effective treatment for nasal swelling and scar tissue following rhinoplasty and revision rhinoplasty. While complications are rare, steroid injections in the nose do have some risk of atrophy at or around the injection site. In the same way that steroids can dissolve scar tissue, they can also affect normal soft tissue in the same way causing a depression in the skin. They can also cause thinning of the skin or hypopigmentation (lightening of the color of the skin). More rarely, they can cause tissue loss. The low risk and incidence of complications with steroid injection is typically outweighed by the benefit derived from their use. Dr. Cangello can provide guidance for the use of steroid injection.

1 Plastic Surgery. Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116320/. Accessed April 13, 2021.
2 Facial Plastic Surgery. Use of 5-Fluorouracil for Management of the Thick-Skinned Nose. Available at: https://pubmed.ncbi.nlm.nih.gov/29409098/. Accessed April 13, 2021.
3 Otorhinolaryngology – Head and Neck Surgery. Rhinoplasty – indications and techniques. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199847/. Accessed April 13, 2021.

Dr. Cangello has either authored or reviewed and approved this content.

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