Rhinoplasty is a procedure that reshapes the nose to improve appearance or function. Following surgery, swelling is expected. While most swelling resolves over several months, a potential concern is the formation of excessive internal scar tissue, sometimes referred to as a “callus” or bony growth. Surgeons call this complication fibrosis, which can obscure the intended surgical result, making the nose appear wider or less defined. Understanding the mechanisms behind this tissue buildup is the first step in prevention.
Understanding Post-Rhinoplasty Fibrosis
The patient term “callus formation” refers to post-surgical fibrosis, which is the body’s excessive production of connective tissue in response to surgical trauma. Surgery triggers an inflammatory cascade where the body attempts to repair the wound by laying down new tissue. When this process is excessive, fibroblasts—the cells responsible for producing collagen—deposit too much scar material beneath the skin, particularly in the nasal tip and the area just above it, known as the supratip.
This excessive scar material feels hard or rubbery and can lead to a complication called a “pollybeak deformity,” where the supratip becomes over-full, resembling a parrot’s beak. Several factors increase a patient’s risk of developing this issue, including having naturally thick or oily nasal skin, undergoing revision surgery, or experiencing prolonged postoperative swelling. If a surgeon creates “dead space”—gaps between the skin and the underlying cartilage—the body may fill this void with disorganized scar tissue, promoting fibrosis.
Immediate Postoperative Prevention Steps
The initial weeks following rhinoplasty are crucial for minimizing the risk of fibrosis. Directly after the procedure, the surgeon applies a splint and tape. Adherence to this compression protocol helps the nasal skin redrape and adhere closely to the underlying bone and cartilage structure, which prevents the formation of dead space. Patients must maintain consistent taping, often for several weeks or months, as directed by the surgeon.
Key Prevention Measures
- Elevating the head, especially while sleeping, and using cold compresses helps control initial inflammatory swelling.
- Strictly avoiding trauma, such as bumping the nose or wearing heavy glasses, prevents re-initiating the inflammatory cycle.
- Avoiding smoking and excessive alcohol consumption supports better overall tissue healing and reduces the risk of complications.
Medical Interventions to Suppress Callus Growth
When general swelling management is insufficient, or if a patient is identified as high-risk, a surgeon may implement specific medical interventions to suppress scar tissue proliferation. The most common and effective strategy involves intralesional corticosteroid injections. These injections are administered directly into the area of concern, most frequently the supratip, to manage persistent swelling and reduce scar material.
Corticosteroids work at the cellular level by dampening the local inflammatory response and inhibiting the activity of fibroblasts, thereby reducing the excessive production of collagen. The timing of these injections is important, often beginning around three to six weeks post-surgery when early scar tissue starts to manifest. The concentration and frequency are carefully titrated by the surgeon, as overuse or improper placement can cause complications like skin thinning or discoloration. Alongside injections, surgeons often prescribe specialized massage techniques, instructing the patient to apply firm, consistent pressure to physically break up newly forming collagen fibers and encourage skin adherence.
Treatment Options for Established Fibrosis
When preventive measures are insufficient, resulting in mature, established fibrosis, the treatment approach shifts to managing the hardened tissue. Targeted corticosteroid injections can still be effective, as the anti-inflammatory properties can help shrink even older, consolidated scar tissue. However, this is typically less successful than treating early-stage fibrosis.
If the fibrosis is extensive and significantly impairs the aesthetic outcome, a surgical revision, also called a secondary rhinoplasty, may become necessary. This corrective procedure is typically delayed until the nose is fully healed, often 6 to 12 months after the initial surgery. During secondary surgery, the surgeon physically removes the excessive fibrous tissue and may use techniques like cartilage grafting to restore structural support and better define the nasal contours.