There is a bump on the Supratip and I feel like it looks like a pollybeak deformity. Do I need a full revision? (photo)

Dear ehiggins,This is a conversation best had with your surgeon and with some morphing software to seeIf the skin is thickened, then steroids will helpBut if you feel the bump and it is hard, then you will likely need to shave it downSo it is difficult to tell exactly how much work needs to be done, but please bring these issues up to your surgeonBest regards,

Dr. Nima

Member, American Academy of Facial Plastic and Reconstructive Surgery

Board Certified Facial Plastic Surgeon

Board Certified in Head and Neck Surgery

Rasping is for bones. That area above your tip is cartilage.Besides lowering the cartilage, attention should be directed to the projection of your tip (how far forward away from your face it comes). I can't quite tell from these photos, but it might help the nose to move the tip closer to your face. Maybe not, but it needs to be evaluated.
How *much* to lower the bump, or make other changes? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify 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 always 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 only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember also that rhinoplasty 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. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Revision rhinoplasty for a polybeak with low nasal bridge. A revision by a VERY  Experienced revision rhinoplasty surgeon will correct your polybeak as well as your low bridge, etc.

It does look like you have a classic pollybeak deformity. It would be ideal if you could post "before" pictures of your rhinoplasty, to get a better sense of how this came about, but it is not uncommon. It seems to me you may have had your dorsum reduced a bit excessively, but this is something a "before" picture would be necessary to diagnose. Regardless, successful correction does not involve rasping, since the supratip fullness is not caused by excess bone. A  revision rhinoplasty would be needed to correct this. I would relay your concerns to your original surgeon, but it probably would be beneficial to obtain a second opinion and see if the plan for correction makes sense. Every surgeon who performs rhinoplasties has patients who require touch-ups or even full revisions, you just need to make sure that you are comfortable with the explanation of what might have happened and how it can be corrected. In my practice about 1/4 of the new patients I see are for revision procedures from surgeries done elsewhere. The good news is that usually this can be corrected. Good luck!

 Much more information is needed including a thorough internal and external examination of the nose to make the determination what is actually causing the poly-beak deformity.  If the poly-beak is created from residual cartilage present,then a surgical rhinoplasty is going to be required.  If this is related to very thick skin, steroid shots would be of some benefit.