Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R palmer, III, Beverly Hills Plastic and Cosmetic Surgeon, creator of the revolutionary beauty concept: “What’s Your Number”.
around lunchtime of May 29th, 2007Beverly Hills Plastic and Cosmetic Surgery “Tip of the Day” from Dr. Francis R palmer, III, Beverly Hills Plastic and Cosmetic Surgeon, creator of the revolutionary beauty concept: “What’s Your Number”.
Post op healing after Rhinoplasty or Revision Rhinoplasty.
This topic continues to come up over and over again…so I thought that I’d spend a few minutes discussing post op healing after Rhinoplasty. Now you may be asking, “what’s the big deal about healing after a Rhinoplasty and why should so many people have questions about their healing after this plastic surgery procedure?
1. Rhinoplasty is performed by lifting up the skin and tissues off of the nasal bones and cartilage framework. This causes swelling after the Rhinoplasty.
2. Rhinoplasty is the act of altering the shape, size, position…etc of the nasal bones and cartilage. This in turn causes more swelling after the Rhinoplasty.
3. Unlike other areas of the body, each additional Rhinoplasty performed increases the amount of scarring and swelling after the Rhinoplasty.
4. All Rhinoplasty will have post op swelling and some of this swelling will go on to form scarring between the skin and the underlying nasal bones and cartilage. The area most prone to this scar accumulation, is the area just above (closer to your eyes) the nasal tip cartilages.
The majority of this post Rhinoplasty swelling leaves within 6-12 months after the Rhinoplasty depending on the patient, the activity level, the number of prevuious Rhinoplasties that were performed on the nose, the length of time the Rhinoplasty took the plastic surgeon to perform and the inherent thickness of the nasal skin. The longer the Rhinoplasty, the more the post op swelling. The thicker the nasal skin, the more swelling and subsequent scarring that’s likely to occur after the Rhinoplasty.
The manipulations, that I have all my Rhinoplasty patients do to their nose starting at 1 month after the Rhinoplasty are aimed at decreasing and removing the swelling in the tissues above the nasal bone and cartilage. These manipulations take about 5 minutes to perform and are done each and every night for a minimum of 6 months and most patients do them for 9 months following their Rhinoplasty.
The manipulations, unlike tape applied to the nose, apply adequate pressure to remove the swelling…even though this is temporary..as the swelling returns…when done on a daily basis this constant and consistent removal of tissue swelling after the Rhinoplasty makes it less likely that the swelling will turn into scar tissue.
That’s the key point! The body does not allow swelling (which is fluid in tissue) to remain indefinetly. The body will instead turn the swelling into scar tissue. Once the scar tissue forms, it’s much more difficult to remove than swelling. This is what the kenalog injections are used for…to dissolve scar tissue that has formed. Most experienced Rhinoplasty Plasttic and Cosmetic Surgeons believe that this occurs by 6 months afte=r the Rhinoplasty and we try to proactively reduce the swelling and hence the amount of scarring within this time frame.
I think, I may have to post a video of a patient performing these nasal manipulations. I just need to find the time.
Dr. Francis R Palmer, III
How do you know if scar tissue has formed?
vanessa :: 10 months, 1 week after
Vanessa,
The nose thickens and the tip become less defined.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 1 week after
I developed excessive scar tissue after rhinoplasty and had the scar tissue removed 3 weeks ago. I am developing a swelling in the same area that the scar tissue previously developed in. What can be done to prevent the reformation of the scar tissue? My doctor is against using any steroid injections due to reported cases of “snuffing” of the skin.
Can anyone use “pressing exercises”? How due you perform them? Is it not risky to press the nose and thereby increase the risk of aggravating the scar tissue?
Please advise.
Roshen :: 10 months, 2 weeks after
Roshen,
100% of my Rhinoplasty patients do post Rhinoplasty nasal manipulations according to my instructions.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
Can you recommend a doctor in Johannesburg, South Africa who can advise me on how to do these manipulations?
RG :: 10 months, 3 weeks after
Hi Dr Palmer,
where on your website can we view the video of one of your patients performing the manipulations?
James :: 10 months, 3 weeks after
Hi Doctor Palmer,
Should kenalog injections only be resorted to after manipulation exercises have been used for 6 months or would they be used simultaneously?
Anne :: 10 months, 3 weeks after
Anne,
They could be used together or alone.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
RG,
I have no idea of who you would see in South Africa for Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
James,
The nasal manipulations are taught to my Rhinoplasty patients in person. I’m not allowed to suggest treatments for other plastic surgeons patients including my manipulations. You’d have to ask the plastic and cosmetic surgeon that did your Rhinoplasty for what he/she wants you to do while under their care. I mention the nasal manipulations so everyone knows they are available.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
I had my second revision surgery 2 years ago but still have a mis-shapen nose with scar tissue formed in unsimetrical bumps on both sides of my upper nostrils. Is ther any thing that can be don to give me an aesthetically pleasing nose?
Thank you.
Nik :: 10 months, 3 weeks after
Nik,
To be honest, I’m not sure. I’d have to see you in consultation and decide what’s the issue as well as look at the quality of your nasal skin. I do use ear cartilage grafts often on Revision Rhinoplasty to re-create a normal looking nasal tip, so theoretically it can be done. I have used this technique many times on Revision Rhinoplasty cases up to the 10th nasal revision (some model from Paris)none of which were my original Rhinoplasty patients.
You can call the office at 310-652-9583 to schedule a consult or e-mail photos of your nose to drfpalmer1@aol.com
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 3 weeks after
Dr. Palmer,
Thank you so much for taking the time to answers these questions. How many doctors do that??
Im 6 weeks post-op closed rhino for a deviation correction and tip lift. Recently I’ve noticed a slight indentation like a line going horizontally across the top of my bridge, very slight but still concerning to me. I Googled the symptoms and I found something about a “necklace indentation when the skin forms….” in a heading of a site, but I when I went to view the page, it said it was a medical/surgical site and you had to be a member to view etc., so I guess only surgeons can access it. Do you anything about this presentation and is it something I should be concerned about? Thank you.
-Kristine
Kristine :: 10 months, 4 weeks after
Correction: When I said across the top of my bridge, I meant to say around the middle of bridge-definitely above my tip, but not all the way to the top of my bridge-right in the middle, like where the cartilage meets the bone I guess.
Thanks again.
Kristine :: 10 months, 4 weeks after
Kristine,
Most likely at the junction of the bone and cartilage as you suggested. Question is: is it really there or is it temporary from swelling? What caused it in the first place if it’s really there…ie a structural issue. This is something that you’ll need to bring up with the plastic and cosmetic surgeon that did your Rhinoplasty. Hopefully, he/she will have some answers and solutions for you.
Dr. Francis R Palmer, III
drfpalmer :: 10 months, 4 weeks after
Dr. Palmer,
I admit that I am not a good healer (I have developed keloids on every scar I have), but my surgeon insisted that it is very rare for patients to develop scar tissue in the nose. I am 5 weeks post-op now and I have noticed hard “bulbs” inside the front tip of my nostrils and my tip has become less defined and thicker than it was 2 weeks post-op. I was told my tip would continue to get smaller! Does it sound like scar tissue already? Also, is it bad that I touch my nose often? I’m obsessed with feeling the differences in it day-to-day. What if I pick a pimple on my nose, or my baby bumps the tip of it? Could it enhance the scar tissue? Thank you for your time…
san :: 11 months, 1 week after
I should clarify: they are not really bulbs (they are not round) as I described, but rather just extra growth that feels as hard as cartilage that was never there before. They can not be seen from the outside. The tip of my nose feels very stiff and one side seems to be popping out more than the other.
san :: 11 months, 1 week after
San,
First you should not be touching your nose unless instructed by the plastic and cosmetisc surgeon that did your Rhinoplasty. This could be post Rhinoplasty swelling and/or scar tissue formation and you should have a conversation with the plastic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 1 week after
Hi Doctor Palmer,
I have been instructed to do “manipulation exercises” after my rhinoplasty. The swelling always returns the next morning. Will this not turn into scar tissue if the swelling continues to re-appear? Should less swelling return after months of performing these exercises?
Anne :: 11 months, 2 weeks after
Anne,
Exactly. The swelling should return to a lesser amount each day…the only thing I tell my patients “don’t overdo the manipulations” as this can cause added tissue trauama to the nose after the Rhinoplasty. I advise my Rhinoplasty patients to do these nasal manipulations no more than once a day for 3-5 minutes.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
At what stage should one accept that the manipulations are no longer working and the swelling is indeed scar tissue? i.e.after how many months should one see the full benefit of doing these manipulations?
Anne :: 11 months, 2 weeks after
Anne,
That’s the million dollar question and would need to be answered by the plastic and cosmetic surgeon following you after the Rhinoplasty. But if I were pressed, I’d say that once the nose no longer gets significantly larger and smaller from day to day…it’s done and what you see is what you’ve got.
As a general rule after more than 20 years of performing Rhinoplasty and Revision Rhinoplasty here are some generalities. First time closed Rhinoplasty takes about 6-7 months worth of manipulations. Open Rhinoplasty first time 6-8 months. Revision Closed Rhinoplasty up to 12 months. Revision Open Rhinoplasty up to 24 months…but each and every case is different.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Dear Doctor,
I just had my open rhino 2 weeks ago. The swelling has decreased but on the left part of the columellar, there is a sharp (and painful) bump (only felt but not seen). When I do the manipulations (after reduction of dorsal hump, alar, and lengthening of tip), pressing the tip parellel and horizontal to cause projection, this bump hurts and turns purple. The rest of the nose is fine. What do you reckon this is? Also, the residual swell seems assymetrical. Yesterday my nose felt soft and malleable but today it feels hard and “stubborn”. What are your thoughts?
Krystal :: 11 months, 2 weeks after
Hi Dr Palmer,
Firstly thanks for replying to queries online. I have not seen any other doctor do this.
I have recently had a rhinoplasty procedure.My doctor has informed me that he would like to use a kenalog injection at 8 weeks post op.
I am worried as i have read about skin atrophy and other side effects.Are these injections safe? What concentrations would be regarded as standard practice?
Irene :: 11 months, 2 weeks after
Hi Dr Palmer,
I have heard that kenalog injections can cause discolouration of the skin and “dents” in the nose surface.
Is this due to it being incorrectly injected or is this a possible side effect?
lucille :: 11 months, 2 weeks after
Krystal,
Are you certain that you’re allowed to manipulate your nose in the described manner at 2 weeks after an open Rhinoplasty? Did the plastic and cosmetic surgeon who performed your Open Rhinoplasty instruct you to manipulate your nose?
I don’t allow any of my Rhinoplasty patients after an open or closed Rhinoplasty to touch their nose at all…for 1 full month from the date of their Rhinoplasty. Manipulations performed before 1 month may, in my opinion, result in rupture of sutures and other self-inflicted trauma to the nasal cartilage and/or skin. Please contact your plastic and cosmetic surgeon and address the issues in your message with him/her.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Irene,
Kenalog injections for post Rhinoplasty scar control is really quite common. yes, there are potential risks of kenalog injections that you should review and discuss with the plastic and cosmetic surgeoon that did your Rhinoplasty. I use kenalog injections on my Rhinoplasty patients when there appears to be prolonged swelling after the Rhinoplasty with resultant thickened skin and scar tissue formation.
This is most common in the area above the tip after a Rhinoplasty. I use kenalog 10 not kenalog 40 which in my opinion can increase the risk potential as it is 4 times as concentrated. I will only inject kenalog once a month for a limted time only. 2-4 injections over 6-9 months would be an average for Rhinoplasty patients that show signs of thickened skin and increased scar. many patients do not require any kenalog shots…only about 10%.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Lucille,
The answer is both. If kenlog is too concentrated, in too high of a volume, placed in the wrong place or too often…it can cause indentations and other issues. I use Kenalog in about 1/10th of all my Rhinoplasties, will only use kenalog 10 and won’t inject more than 0.2cc’s at any one time and only once a month. Typically it’s 2-4 or maybe 6 injections over the post-Rhinoplasty course.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Thank you Doctor,
I feel a bit more assured about having these injections done.
Is it true that the injection should be done “deep” into the subcutaneous layer and not in the dermis?
lucille :: 11 months, 2 weeks after
Dear Doctor,
I refer to your reply to Lucille when you say that you only use Kenalog 10 and 0.2cc’s once a month.
Have you encountered any complications in your extensive career with these injections in these concentrations?
Janine :: 11 months, 2 weeks after
Good day Dr Palmer,
I have just had a kenalog injection done and am weary of doing my manipulations as per normal as i feel i should not touch the area for a few days.
My doctor thinks it would be fine to do the manipulations everyday as per usual.
What is your opinion?
Ethol :: 11 months, 2 weeks after
Lucille,
Yes, that is correct…the purpose of the kenalog injection after a Rhinoplasty is to decrease the subcutaneous scar tissue and this is deep to the skin.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Janine,
Even at the mentioned concentrations kenalog may cause temporary indentations. The remedy for these are to avoid further kenalog to the area for a month or two and allow the areas to fill in with the normal scar formation. This is an art just like Rhinoplasty and medicine in general.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Ethol,
I advise you to follow the directions of the plastic and cosmetic surgeon that did your Rhinoplasty and kenalog injections. FYI, I allow my Rhinoplasty patients to perform their nasal manipulations the evening after they have kenalog injections.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Thank u for the information.
When would you say is the best time to resort to kenalog injections?
During the first 6 months while one is doing the manipulations or after the manipulations have stopped having any effect?
Lucille :: 11 months, 2 weeks after
Do you spread the dosage of the injections over the area of the scar tissue or inject just once into the layer and wait for the next month to “redirect” your focus?
Irene :: 11 months, 2 weeks after
Irene,
Every plastic and cosmetic surgeon will do kenalog injections differently and even in a different manner and pattern from Rhinoplasty patient to patient. No two Rhinoplasty cases are the same and you’ll have to trust the expertise of the plastic and cosmetic surgeon to perform the kenalog injections after your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Lucille,
I have found it always best to use kenalog in the first 6 months only if really needed. As I mentioned before, in my Rhinoplasty practice…it’s less than 10% of the cases. I do a great deal of complicated Revision Rhinoplasty surgery as well as primary Rhinoplasty and the Revision Rhinoplasty cases are the ones that usually require the kenalog.
If kenalog is used after 6 months, the indentations if any may not resolve.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 2 weeks after
Is the kenalog injection as effective if only used 3 months after the operation instead of at 1 or 2 months?
Alice :: 11 months, 3 weeks after
Alice, The timing of kenalog injections will be deternmined if and when the subQ scar tissue is built up to a certain level. This may occur at anytime after the Rhinoplasty but is most cpommon at about 3-6 months. Kenalog is always effective but will work best as the scar is beginning to form after the Rhinoplasty (2-6 months) versus once the scar is more mature (7-12 months or longer).
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 3 weeks after
I have read that a doctor should take care to aspirate the injection when giving a kenalog injection. They say that this is to avoid injecting into a blood vessel.
What does all this mean?
Alice :: 11 months, 3 weeks after
Alice,
That is correct but applies more to kenalog injected into the inferior turbinates inside the nose. They have spaces for blood to pool and swell and if he kenalog is injected into these spaces, there have been reported cases of it causing blindness. This should not be confused with a subcutaneous tissue injection of 0.1cc of kenalog 10 for post op Rhinoplasty….but your plastic surgeon should discuss the risks and benefits with you before the kenalog treatment.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 3 weeks after
Good day Doctor,
1) Has the manipulations ever resulted in a total correction of what would have otherwise resulted in a soft tissue pollybeak?
2) Your reply to the previous query said blindness could result if injected into the inferior turbinates. Is it not possible to somehow incorrectly inject into these even if the injection is meant to be a subcutaneous tissue scar remedy?
Anthony :: 11 months, 3 weeks after
Anthony,
1. The purpose of the nasal manipulations and kenalog injections are to prevent “Polly Beak” deformity which is the extreme formation of subcutaneous scar tissue in the supra-tip (above the tip) area. If someon has done the manipulations and kenalog, there’s really no way to say what amount of scar tissue would have formed if nothing was done. Nor is it possible to say that these things will prevent all “Polly Beak” deformities from happening. The purpose is prevention.
2. Things can always be done incorrectly (that’s why you should have an experienced plastic and cosmetic surgeon) but the supratip area doesn’t have the same anatomy as the inferior turbinates or the same risk of complication with kenalog use. Once again, all risks should be explained by the plastic and cosmetic surgeon who is going to use the kenalog in either area.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 3 weeks after
Hi Doctor Palmer,
Why will the kenalog injection make any difference? If the cause of the fluid is the fact that the skin has not draped or contracted, will that just re-occur even if the kenelog injection breaks down the scar tissue?
Or will the skin be forced to contract?
Amy :: 11 months, 4 weeks after
Amy,
The kenalog stops further scar tissue from blunting the nasal tip narrowing that’s part of a Rhinoplasty. The excess nasal skin typically shrinks to fit the smaller nasal frame after a Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 11 months, 4 weeks after
Hi Doctor Palmer,
I am an indian male with very thick skin.
After my rhinoplasty procedure, i have developed swelling in the supratip region. After a few consultations with various doctors, they seem to be of the opinion that the skin “envelope” has not contracted significantly to fit the new bone structure. Will kenalog help under these circumstances? i.e. will the skin contract after the injection if it did not contract sufficiently in the first place?
anban :: 1 year after
Anban,
Depends on how far post-op you are after your Rhinoplasty. If it’s within 6 months there is a better chance of this than if you are 9 months or longer after your Rhinoplasty. Laser skin resurfacing, once the nasal skin is healed is also a good way to shrink down the skin.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Thank you for the reply,
I am 2.5 months post op. Is it possible to do laser resurfacing in the first 6 months if one opts to go the kenalog route aswell.
What does laser resurfacing do? Have you had success with this method?
anban :: 1 year after
Hi Doctor,
I have read that some plastic surgeons use other steroids as opposed to kenalog. Which steroids are commonly used and do they work as well as kenalog?
Greta :: 1 year after
In the 10% of patients that you have used kenalog injections on, on average, how many injections over how many months has it taken to receive a satisfactory result?
bronwym :: 1 year after
Anban,
Yes, I have had great success with laser resyrfacing of the nose but it can’t be done for about 10-12 months after the Rhinoplasty…the blood supoply to the nasal skin must be completely normalized before the laser.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Bronwyn,
Could be as few as 1 or as many as 10 at monthly inervals. Ever nose and patient is different after Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Greta,
I’m only aware of kenalog 10 (which I use) and kenalog 40 which I believe is too strong and don’t use.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Hi Doctor,
I have had some scar tissue excised 3 months ago but did not have any bone work done. My skin has not shrunk down sufficiently as yet. Would laser resurfacing be an option earlier than 10-12 months in my scenario in order to prevent the fluid from turning into scar tissue?
barry :: 1 year after
Hi,
I am 4 weeks post-op from revision rhinoplasty which was done 19 years ago, the first doctor had undercorrected so I had a septoplasty, narrowing of the nose, basically decrease of the size of my nose. I returned at 2 weeks post-op with a concern of a twisted look to the nose when looking straight on, almost shaped like a gentle paranthesis sign. The doctor agreed, said since he is right handed he came in with more force from one side which contributed to this curve. He instructed me to stabilize the mid portion of my nose while pushing with a decent amount of force on the supratip portion of my nose to straighten it, hold for 30 seconds and do 5-6 times a day. So I have been doing this for 2 weeks and the nose is straighter but still somewhat curved. I followed up with him yesterday and he said to continue the manipulation. Have you heard of manipulating with force at such an early stage? I just find it odd that I am given the responsiblity to correct the shape of my nose and worry about the outcome.
Thanks so much for your time, it is so appreciated.
Christine :: 1 year after
Christine,
No, I typically won’t allow post Rhinoplasty patients to manipulate their noses for a full month after a Rhinoplasty. Your plastic and cosemtic surgeon, that did your Rhinoplasty, is giving you instructions which you must decide to follow or seek another plastic surgeon who will take over your care. You didn’t mention if your bones were broken….external manipulation is unlikely to move the septum one way opr the other. If you are concerned, you may consider seeking a second opinion from a plastic and cosmetic surgeon in your area for more specific advice and recommendations because since I wasn’t present at your Rhinoplasty, I’m afraid I can’t comment further.
Dr. Francis R Palmer, III
drfpalmer :: 1 year after
Does laser resurfacing shrink or tighten the skin?
Is it maintainable or will the skin expand again in a month or two?
Thanks
bernice :: 1 year, 1 month after
How many kenalog injections does it typically take to correct scar tissue formation?
I have receives my first one at 4 months post op, does this mean i can only get 2 more monthly injections as one should not have injections after 6 months post op?
Terry :: 1 year, 1 month after
Hi Doc,
I had a few rhinos, the bone structure at the bridge looks and feels great. The issue is excess scar tissue/skin which makes my nose wider. I receive kenalog injections every 8 months but thats when it seems to wear off. four days after an injection my bridge looks skinner and great but it doesnt last. Will it ever last? I dont feel like doing ejections forever? what can be done, maybe laser resurfacing? or how about maybe tightening the scar tissue/skin at the bridge by making an incision at both side of bridge where it meets face and pulling down??Well i thank you in advance, its appreciated…
nick :: 1 year, 1 month after
Bernice,
Laser resurfacing does both. It blasts the top layers of the dermis which is then replaced with nice new collagen. As long as you avoid too much sun and don’t have too deep of a Laser, you should enjoy the benefits for years to come. Now, having said all of that…most celebrity Lift patients have 3 inches of skin removed from the face and my full face and neck lifts remove even more. There are no Lasers, Radiofrequency, or other machines today that can tighten or shrink skin more than several mm’s to a centimeter….there are 2.54 centimeters in 1 inch and 10 mm’s in every centimeter which means these procedures can’t tighten or shrink the skin more than 1/2 an inch. If you have more sagging skin than that don’t rely on the Laser to do the heavy lifting. That’s unrealistic and that’s what a lift is for.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Terry,
No, kenalog injections can be tailor made to accomplish their goal which is to decrease post Rhinoplasty scar formation. They work best within the first 6 months post Rhinoplasty but can be continued longer. I don’t use anything stronger than kenalog 10 and won’t inject the nose more often than once a month…but you’ll have to follow the instructions of the plastic and cosmetic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
Nick,
Yes, sounds like a tough problem. After 1 year, you might consider a laser resurfacing of the nose which thins the skin and the nose without really eliminating the internal scar tissue. No, those incisions may not look/heal all that well and could be unsightly.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 1 month after
IS IT OK TO INJECT KENALOG INTO THE LIPS WITHOUT DESTROYING AND RUINING THE LIPS OF THEM??…I HAVE SEVER SCAR TISSUE FROM A LIP AUGMENTATION.
theresa :: 1 year, 1 month after
IS IT OK TO INJECT KENALOG INTO THE LIPS WITHOUT DESTROYING AND RUINING THE LOOKS OF THEM??…I HAVE SEVER SCAR TISSUE FROM A LIP AUGMENTATION.
theresa :: 1 year, 1 month after
Theresa,
Kenalog injected anywhere, including into the lips, may cause atrophy of normal tissues. Be sure you understand the possible complications before having the plastic and cosmetic surgeon do the kenalog injections.
Dr. Francis Palmer
drfpalmer :: 1 year, 2 months after
Hi Doctor,
What volume of Kenalog 10 due you inject at monthly intervals? i.e. How many millilitres?
Thanks
Catherine :: 1 year, 2 months after
Catherine,
I use kenalog 10 between 0.1 to 0.2 cc’s but other plastic and cosmetic surgeons that do Rhinoplasty and Revision Rhinoplasty use more concentrated kenalog or a larger volume. The plastic and cosmetic surgeon that did your Rhinoplasty most likely has his/her own ideas on the subject.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Dear Dr Palmer
This blog is absolutely wonderful, I have been doing research for my revision-rhinoplasty and this blog answers so many questions for me.
4 months ago I had a open revision rhinoplasty. A medial overlay was done, and the bonypart was rasped, and the cartilages were trimmed and I had a columella-drip which was pushed in. The thing is that I have almost not been able to smell anything since the surgery, I breathe fine though… and for some reason I can’t really taste anything either.. I dont understand it…it is of course really frustrating because I love food. Is this something that could be corrected with surgery.. in case it isnt just swelling-in-the-oining (which my ps told me)?
sincerely nina
nina :: 1 year, 2 months after
Dear Dr. Palmer,
I had open rhinoplasty 1 month ago. My doctor injected kenalog into the tip at 3 weeks post op. Is this too soon? I feel as though my nose is becoming too small for my face. Also, after 1 month I still have bruising in my cheeks. Have you seen bruising last this long?
Thank you so much for your input,
Kathy
Kathy :: 1 year, 2 months after
Kathy,
Bruising is highly variable but as always the person to ask specific questions about your Rhinoplasty, nasal tip, kenalog injections post-Rhinoplasty is the plastic and cosmetic surgeon that did your Rhinoplasty.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 2 months after
Hello Doctor,
thank you so much for your time!
I had rhinoplasty about 22 years ago. The tip (bottom third) of my nose is very bulbous and the bridge is very narrow. (Looks like an upside-down tootsie pop!)
Is it possible to get kenalog or cortisone injections into the bulbous areas of my nose in order to shrink the tissue down? Has is been too long for this to work (I’m now 38)? Any other, non-surgical treatments you can recommend?
thanks,
Zoe
Zoe :: 1 year, 3 months after
Zoe,
Kenalog injections are for post Rhinoplasty healing and in my opinion wouldn’t be recommended 22 years after your Rhinoplasty. I’d have to see pictures of your nose or you in person to get a better feel of what’s going on…is the tip bulbous because of thick skin, excess sub-Q scar or just large tip cartilages…all of which would require a different course of action. You can e-mail pics to my staff at drfpalmer1@aol.com or call for a consult or phone consult to discuss the photos at 310-652-9583.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Our daughter had a combination rhinoplasty/chin implant on July 10, ‘08. The chin implant is a large extended anatomic Implantech with a 6mm projection which was placed through the mouth. We’re wondering if swelling causes the projection to look more pronounced. Also the area around her mouth looks tight and her mouth has some asymmetry, especially evident when she talks. Is this normal and a result of swelling? How long would you expect this to last? Thanks for your reply. Terry
Terry :: 1 year, 3 months after
Terry,
6mm projection is quite a large amount and that maybe what you and she are noticing. Unless chins are severely recessed,I typically use a size small or medium chin implant placed from an incision below the chin. You can send profile photos by e-mail to drfpalmer1@aol.com or call the office at 310-652-9583 to schedule an in person consultation. If you and she decide to have the implant removed, you might want to consider having the plastic and cosmetic surgeon use the submental skin incision instead of going through the mouth.
Dr. Francis R Palmer, III
drfpalmer :: 1 year, 3 months after
Dr. Palmer,
I am now 2 months post open rhinoplasty. One of my concerns is that I have an indentation on one side of my nose (the bridge). It looks as though I pressed my finger into it and it stayed that way. My doctor ignores my concern and has not really answered my questions regarding this dent. I will wait it out to ensure this isn’t still swelling - it has been there since the day the cast came off though. But if the dent does not go away, what do you suggest to fix this? Would I have to undergo another surgery?
Thank you so much for your advice/input.
Kathy
Kathy :: 1 year, 3 months after