Advice needed on revision rhinoplasty to correct polly beak deformity (Photo)

Question

I underwent rhinoplasty several years ago and as you can see from the pictures the results were disastrous. . I developed an an inverted V deformity and pollybeak. I was also left with a small-round bump at the tip of my nose. My nose used to have a slight hump and more of a straight bridge, but far too much of my nasal bridge was removed. I'd also like to improve my unflattering slopey jawline/double chin but I am not willing to consider implants. Would a neck liposuction do the trick?

Alejandro Nogueira, MD · Answer

I agree your result is really poor. Please find ahead my vision of situation and potential solutions to the issued I have detected:-I would not say you have polly beak deformity, you have a problem that is near to be such polly beak but actually is more a supratip massive fibrosis and excess of septum which has been under resected; the under resection plus the massive fibrosis makes the soft bridge prominence; all this must be shaven down-I would neither say you suffer inverted V deformity, to the contrary, your dorsum is too broad; you are not a case for spreader grafts but for correctly done osteotomies-the upper part of the dorsum and the center of the bridge are over resected, and this may need grafting to raise the level of the dorsum, this graft may cover also the lower dorsum, since once the fibrosis is removed there the level will be also low-I notice too high and incompetent osteotomies, they have to be repeated well done and at the righ location on Joseph's angle (formed between maxilla and nose)-the tip lacks definition, is too high (slight over rotation) and is too thick; needs tip grafting and repair-you have a oversized weak / soft triangle (the area without cartilage at the rim of the nostril just were the dome is formed), leaving a hollow or contracted area; this needs rim grafting to correct this-your rims are retracted and high, you need also rim grafting (of other kind) at the lower lateral crurasYour nose is of the top difficulty, not just a revision case, is a real artistic work full of skilled technices of very precise execution, very few surgeons master such cases. Do travel wherever is necessary to receive the right excellent surgery you need.

Steven M. Denenberg, MD · Answer

See the "Web reference" link, just below my response. I made a couple of computer morphs, and animations of the morphs, to show the changes that are possible for your nose in truly expert hands.
Even though your bridge was lowered too much, it's possible that you wouldn't need to have it built up. In the morphs, I elevated the tip of your nose, and brought it back closer to your face. Those two changes make the tip less prominent, and that lessens the need to build up the bridge. See what you think.Although building up a bridge is certainly possible, I like to avoid it whenever I can, because it adds complexity to the operation and adds more ways that something can be not-quite-right after surgery.I also elevated the columella, which is the piece of skin that separates the two nostrils. Elevating that piece makes the nose less prominent, and draws attention away from the nose. The woman in the short attached video had her columella elevated.You do have that inverted-V, which probably can be very effectively addressed by narrowing the nasal bones. My philosophy on a nose like yours is not necessarily to try to make it like it was, which is unrealistically difficult. Rather, make changes that are as predictable as possible, to minimize the irritating features, and get the nose to a position where it's fine and it doesn't draw attention, and the problems are too small to worry about any more.You should understand that the changes I demonstrated in the morphs require very advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Web reference" link on how to stay out of trouble while searching for a rhinoplasty surgeon.

Giancarlo Zuliani, MD · Answer

Hello and thanks for your question. You are indeed correct that you are suffering from a pollybeak. You have short nasal bone and I'm certain spreader grafts were not inserted into your mid vault to prevent this complication after a hump takedown. The pollybeak is either from scar or from a high anterior septal angle. At this point You will need cartilage grafting to restore height to your nose and projection to your nasal tip. In terms of our jawline, liposuction can help the submittal fat but filler placed at our chin or the angle of your mandible can give you the definition you may desire. Good luck!

Minas Constantinides, MD · Answer

You have several challenging problems to correct, so you will have many quite different "answers" as to how to correct them best. I believe that your inverted V deformity is from over-resection of your bony dorsum, destabilizing your upper lateral cartilages at their upper junction with the bones. Although spreader grafts are required for stability, I don't think they will be enough. In addition I would consider elevating your bony bridge, most likely with diced cartilage wrapped in temporalis fascia. Your columella and tip area ought to be reconfigured as well.You are a good candidate for liposuction of the submental area if you decide upon surgery. You may also consider Kybella or CoolSculpting, depending upon your goals and timing.An examination by an experienced rhinoplasty surgeon is essential before any definitive plan is formulated. For more about revision rhinoplasty, please see my link below.

Michael Yerukhim, MD · Answer

Thank you for your question, and I'm sorry you're having a hard time after your surgery. Don't hesitate to shop around and get a couple of opinions from experienced revision Rhinoplasty surgwons before your decision. Also try to get the operative report so that your consultations can be most productive. You do have a classic inverted V, which needs spreader grafts. You do have a classic poly beak, which may be from scarring or from taking off too much dorsum. I also think your Ala are a little retracted and need to be brought down. Columella is also hanging, but needs to be addressed carefully, so as not to overrotate your nose. There's also a weird point just under the tip - I'm curious if a columella strut graft was placed and is sticking out. An in-person consultation is the best next step. Regarding your chin, submental liposuction is a good option, especially if you're already having surgery, or possibly kybella injections. Good luck!

Bradford A. Bader, MD · Answer

Thank you for the photos. They demonstrate the issues very well. The bridge of your nose was lowered too much. This makes the supratip look too prominent, which creates the pollybeak deformity. The solution to this problem is a dorsal onlay graft. This will raise the height of the bridge of the nose and create a much more pleasing profile. The onlay graft will also help to camouflage the inverted-V deformity. The nasal tip needs refinement and the relationship between your nostrils and the columella needs to be addressed. The neck concern can be improved with liposuction or with Kybella injections. This will be a challenging nasal surgery so I recommend that you 
seek consultation with a very experienced revision rhinoplasty expert.

William Portuese, MD · Answer

A revision rhinoplasty procedure can accomplish reducing the poly-beak,  and adding additional cartilage to the upper bridge profile. The inverted V. deformity is treated with osteotomies placed in the nasal bones, and spreader grafts placed underneath both concave upper lateral cartilages in the midportion of the nose. In addition, the hanging columella can also be reduced.  Liposuction in the neck can help with a double chin, and a chin implant is not required

Ben Talei, MD · Answer

You can definitively get a significant improvement and more natural appearance with a revision.   I have dealt with almost that same exact nose many many times and the patients are extremely happy after revision. Keep in mind that the nose is very tricky and revision rhinoplasty is one of the most difficult surgeries out there. Look through as many photos as possible and try to find consistent results on primary and revision noses.  As for the neck, lipo should do the trick

Arian Mowlavi, MD, FACS (license on probation) · Answer

You are absolutely correct in that you have an inverted "V' deformity that formed from over-resection and dissection of the upper lateral cartilages off of the dorsal cartilaginous septum. In order to correct this problem, you will require revision of your nasal dorsum with placement of secured spreader grafts along the entire middle vault. In addition, I see a full supratip region which needs to be lowered in order to provide your nasal tip more of a highlight. The highlight is created by having the nasal tip lead the dorsum; The dorsum as it is now is higher than the tip and distracting from you nasal tip. An examination and consultation is necessary to provide you details on correcting your concerns.

Richard W. Fleming, MD (retired) · Answer

Unfortunately you have more than a polly beak with fullness above the nasal tip. As you stated you do have an inverted V deformity, a low bridge, and a hanging columella with a poorly defined tip. Consult with an experienced revision rhinoplasty specialist.

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