Tip is super droopy 2 years post-op. Pollybeak? (photo)

Question

I had a rhinoplasty and septoplasty about two years ago and the more time that passes the worse my nose is getting. My tip is super droopy now and there is a bump on the side of my bridge. I know I have thick skin but I’m wondering if I have pollybeak, or what some indications of Pollybeak are.

Steven M. Denenberg, MD · Answer

It just looks to me as though the tip of your nose isn't as high as you wanted it, and the bridge is too prominent. In a revision operation, the tip can be elevated in a fashion to prevent it from drooping again, and the bridge lowered more, to match the new position of the tip better. 
How *much* to elevate the tip, or lower the bridge, or make other changes? We figure that out with morphs, well before surgery. Morphs could also help you identify better just what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should really be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and the surgeon has that information and judgment best.)

Finally, remember that rhinoplasty, and especially revision rhinonplasty, is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. It's much better to not have surgery than to have inexpertly-performed surgery.

Eric M. Joseph, MD · Answer

Thank you for posting this question with your photos. You do not have a terrible nasal appearance. I can see that you have lost a bit of tip support which is largely causing the fullness above your tip. If you have severe dissatisfaction with your nasal appearance, revision rhinoplasty may be considered for achieving tip rotation, polly beak lowering, and a less distracting appearance. Wishing you well moving forward. Sincerely, Dr Joseph

Ruslan Zhuravsky, DO · Answer

Hi, Good question. The term "Pollybeak" is used to describe a nasal shape that has excess fullness above the tip. This makes the nose looked curved down like the top of a parrot beak. It can be from excess septum or soft tissue in this area. I personally find it is most often due to the combination or poor alignment and planning of rations, leaving the septum too high at the bottom, as well as inadequate tip support. Thick skin is often used as a scapegoat, but rarely the real issue. Yes, unfortunately your nose falls into that category. Your skin does not appear to be very thick, I would estimate moderate based on photos. If it was very thick, you would not see as many contours of your nose as you do. It seems the biggest issue is the proportion of the septal height to the tip projection. The tip cartilages are also convex and cephalically oriented. This give the tip a rounder appearance (not the skin). These are things that can be changed with proper restructuring of the nasal shape. If you decide to pursue a revision, please make sure to choose a surgeon that truly specializes in rhinoplasty. Go to several consultations and compare the assessments and explanations that you get. Good luck!

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The true cause of a pollybeak deformity is due to lack of appropriate tip support. Based on your photographs, you may benefit from a revision rhinoplasty. Your surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. Establishing better tip support and elevation will also be important. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Sean Fisher, MD · Answer

Yes, the profile view shows a secondary polybeak deformity with supratip fullness. This can occur for a variety of reasons such as excess scar formation in the supratip and change in nasal tip position over time. Tip changes can occur depending on the techniques that were used in your initial operation- certain techniques are more stable than others in their ability to increase and maintain tip elevation. If you are two years out from your operation, the best course of action to address this would be through a full revision. Depending on the cause, some component of scar tissue removal or adjustments to tip positioning using a strong graft, such as a septal extension graft, may be necessary. A well-trained rhinoplasty surgeon should be able to help you decide on the best course of action based on an in-person evaluation. 
Sean FisherAesthetic Plastic Surgeon Seattle, WA

William Portuese, MD · Answer

Polly beak can be caused from two issues, thick skin and residual dorsal/tip cartilage. To treat thick skin require steroid shots to reduce the swelling in the supra tip area of the nose. If the poly beak is caused from excess cartilage, then a revision rhinoplasty is required. To prevent the tip of the nose from drooping down dynamically when smiling requires releasing of the depressor septi ligament.

Tip is super droopy 2 years post-op. Pollybeak? (photo)

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