Possible Deformities after Rhinoplaty? Pollybeak and Deep Alar Crease?

Question

I had a primary rhinoplasty a while back. First, is it possible pollybeak and saddlenose deformities formed? A lot of my bridge was removed which was not discussed with me prior. Second, I have deep shadows that make my tip look pinched. Breathing issues have occurred as well. What type of grafts would you use to fix this? Overall, what would you recommend with this case based on what I've provided?

Stephen J. Pincus, MD · Answer

Sorry for your disappointing results. Basically, when the underlying structure of the nasal dorsum is reduced, the skin at the top of the nose, which is thinner, can redrape quite effectively. However, the more sebaceous, thicker skin towards the bottom of your nose will shrink down only "so much", based upon the amount of excess skin and the underlying structure. If the amount of skin is slightly more than the underlying structure that it covers, it shrinks down to the smallest volume for the surface area. That is a "ball"! In other words, in "rounds up". Now there are situations where the so-called "pollybeak" is actually excess caudal septal cartilage. But most of the time, it is this excess skin. And the best way to resolve the issue is to take up some of the slack under the skin by building back some of the support that was removed! Also, occasionally, this is further improved with a tip graft to slightly project the bottom of the nose and reduce the rounding. Finally, the pinching above the nostrils is also do to an over-resection. In this case, it's the cartilages that support the side walls and help form the tip. In an attempt to produce a narrower tip, some surgeons remove cartilage in this area. However, it has to be done with an eye towards maintaining support to spaces in the nose through which air flows, In this case, the "internal valves". This is the narrowest area in a Caucasian nose and small changes in the cross section of which can be quite symptomatic! You can get a good idea by pulling your cheek to the side, which will expand that area and give you instant relief. And there are techniques to do that surgically, as well!

Jeffrey H. Spiegel, MD · Answer

I was just giving a lecture on pollybeak yesterday.  You don't have a saddles nose, but, you have a slight pollybeak which could be due to too much cartilage remaining, but, more likely is due to skin thickening. We have many ways (right in the office) to address that.  Breathing issues are another issue and that would require a more in depth evaluation.

Possible Deformities after Rhinoplaty? Pollybeak and Deep Alar Crease?

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Possible Deformities after Rhinoplaty? Pollybeak and Deep Alar Crease?

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Everything you need to know about Revision Rhinoplasty

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