Do I have a polly beak deformity? Is it a simple procedure to fix it? (photos)

Question

I had my first rhinoplasty 10 months ago. I am not pleased with the results my tip is too pointy and i believe i have a pollybeak deformity and my septum is too thin. My nose is much worse than it was before. My doctor said my tip needs to be a bit bigger and it can be done with closed revision rhinoplasty. But i think it is not that simple and more work needs to be done to fix my problem. is he right ? Do i need any external grafting for tip support?

Alejandro Nogueira, MD · Answer

Your result is poor; let me list your issues, causes and solutions:-open roof deformity: seems your surgeon did not perform the mandatory (when the dorsum is shaved) osteotomies, or either they were incompetent or eventually some synostosys (bone fusion) between septum and nasal bones was not freed; solution: good dorsal bone release and complete osteotomies-as a consequence of the former you developed the typically associated inverted V deformity, best treated with tiny (in your case, you have very thin skin and thick ones may result in too broad dorsum) spacer grafts (best taken from nasal septum).-your tip is too sharp and pointy, resulting grotesque and artificial; if no graft was applied and if this was not like this preoperatively and viewing you got closed approach I can guess with certainty your surgeon performed a delivery technique of cartilage extraction and a too aggressive domal plication; this has to be accessed, revisited and eventually reverted by means of tip grafting-supratip prominence (aka polly beak): best treated with dorsal supratip shaving and / or tip re-projection by a columellar strut, a tip graft or bothUnder no circumstances you should accept a minor procedure, a closed approach or a minimally invassive solution; yours is a 7 out of 10 difficulty scale of revision rhinoplasties (which always triple in difficulty primary ones) case and needs 4-5 hours of surgical time.Seek the services of a well experienced revision rhinoplasty surgeon, do travel wherever is necessary.PS: considering your filmy and transparent skin, the dorsal work (spacers and so on) may become visible and look evident, requiring a temporal fascia graft to hide all the subcutaneous dorsal structures (to be decided introp).

Ira D. Papel, MD · Answer

When the area above the tip projects more than the tip itself, you have a polly beak. This can mean the tip has dropped, or the cartilage of the supratip area is too high. The tip does look very thin for the size of your nose. These problems are repairable, by either raising the tip or trimming the supratip. Some cartilage grafting would be needed, probably using an external rhinoplasty approach. To tell for sure a personal consultation would be needed.

Fred J. Bressler, MD, FACS · Answer

A complete evaluation, examination and review of your operative reports would be important in deciding the best course of action for a potential revision. That said, your basal view appears to show a cartilage shield type tip graft which appears too sharp and may need to be removed. Additionally, your dorsum is too full in the supratip and nasal bone region. This may not be true polly beak deformity, but a more flattering profile could be accomplished for you via a revision. In my view, your case would require a full open approach revision rhinoplasty and not a simple tweek via a closed revision. Additionally, your frontal view suggests that you may need improved middle vault definition with cartilage grafts. Overall, I share your concerns that correction may not be as simple as one opinion suggests. Perhaps a second opinion with a revision rhinoplasty specialist could help you understand your options. Take your time in decided what you should do. Fortunately, you appear to be an excellent candidate for revision. Best Regards.

Do I have a polly beak deformity? Is it a simple procedure to fix it? (photos)

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