1 year post op - Confused about fluctuating pollybeak deformity - will I need a revision or if this normal? (Photos)

Based on the photos and your description, I would initially try a local injection of a corticosteroid for 2-3 sessions, as it's possible that there is more fibrous tissue in the area than there should be. If this doesn't result in a complete or partial improvement, I would proceed with a revision rhinoplasty, where I would remove any existing fibrous tissue on the nasal dorsum (bridge) and perform a good structural support of the nasal tip.

Based on the photographs, I do believe you would benefit from a revision surgery. The main problem seems to be a lack of tip projection. Because the tip is droopy, it looks like a pollybeak. I would recommend increasing the tip projection and possibly some attention the supratip area.

I'm confused why your surgeon did not want to inject it... i would get a 2nd opinion. the most important thing ot know is that if it's still fluctuating, then yes it's likely just swelling, since a true fixed structure in there would not be able to "fluctuate"; however, it can be creating deadspace for scar tissue to form, which is why taping and/or steroids can help!!

Your nose shows indications of a very poor quality work:
-collapsing tip, unsupported, over resected
-upturned tip, sunken columella
-alar rim retraction
-supratip prominence (aka polly beak)

In general there is a massive over resection / under supporting revision rhinoplasty case, needing a complex re-structuring procedure with varied types of graftings. The on/off sweeling indicates tissue damage and poor vascularization, not a major barrier but a warking for the next surgeon: be very delicate managing tissues.

Find a surgeon experienced and talented with complex nasal revisions.

Thank you for your question. Supratip deformities can and do occur after rhinoplasty. As a surgeon who performs many rhinoplasties per year, I treat these very aggressively with steroid injections, taping, and the Noseperfect device. You should be able to have an excellent result even this late in the game. Best wishes to you.

There should not be an extreme amount of nasal swelling one year after surgery. If you like how your nose looks on days when your nose is not swollen, indeed, a steroid injection may be helpful. Injecting the supra tip is a low-risk location, and it has been clinically shown to be beneficial for those with persistent swelling in this area. We typically use triamcinolone acetonide, 10 mg per milliliter, approximately 0.2 ml. Hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include correction of pollybeak deformity, establishing improved tip stability, among other maneuvers. 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

After rhinoplasty the tip area, including supra-tip, heals last. Patients with thick skin (especially if the degree of the thickness is high) can experience swelling up ta 2- 3 years on that area. Since skeletal tissues can't change time to time fluctuation of the nose view is a sign of swelling on the skin. With the influence of the fluctuating hormone levels caused by the physiologic menstrual cycle on female patients the swelling on the nose can change time to time. However it is very common that there can be scar formation and the deformity can be permanent if this situation persists. I would recommend taping on the supra-tip for sure and if the situation persists I could have advice steroid application on the site.