Is this a PolyBeak? What happened during the healing? (photos)

Question

I had a rhinoplasty done and the after surgery photos were perfect. My nose had a slope it was tiny and exactly what i asked for. I’m almost over a year later and it looks nothing like the after photos. My tip is huge and it doesn’t feel defined also my slope isn’t right and it feels dense. I am persian and was told i have thick skin but will my tip fix itself with time?

Jonathan Kulbersh, MD · Answer

Hello and thank you for your question. Before recommending any further surgery, I would like to know first how long it has been since your initial rhinoplasty. It can take up to a full year (or even longer in some cases) for swelling to subside completely and the final outcome to become evident. If you are past the one-year mark and unhappy with your result, further treatment may be necessary. This could mean steroid injections if the problem is primarily scar tissue, or a revision rhinoplasty if more correction is needed. Keep in mind that revision rhinoplasty is often more complex than the first surgery, due to scarring, loss of structural support, and other factors. Make sure you choose a very experienced, board-certified facial plastic surgeon for your procedure who has the expertise and skill to produce the best result for you.

Edwin F. Williams, III, MD · Answer

Thank you for your question. Depending on how long ago your surgery was performed, it could still be swelling (especially if you have thick skin). The supratip and tip of the nose are the areas that usually hold on to the swelling longest. It can take up to a full year (sometimes even longer with thick skin) for the swelling to go down. If you are having concerns, I recommend reaching out to your surgeon for an in-person examination. Best of luck!

Steven J. Pearlman, MD, FACS · Answer

It is important to feel an examine your  in person to figure out what the cause is. If it's just thickened skin and scar tissue, injections may help. You should first go back to your surgeon to discuss your issues. If you are unsatisfied with the plan, see an expert in revision rhinoplasty to discuss how this can be improved.

Robert Ciardullo, MD · Answer

Do you have a poly beak, and why? The convex appearance in profile of the lower half of your nose is what is commonly referred to as a poly beak. However the important question is whether that convexity is due to the Cartlidge below or to a buildup of scar tissue above the Cartlidge, beneath the skin. What you are experiencing is a very common phenomenon .on the operating table the surgeon often makes the tip high and the area above the tip either straight or even a little concave as your pictures are. With time however several factors come into play. First of all the tip rotates slightly downward and the projection is sometimes reduced as scar tissue forms behind the columella and contracts. The second factor is a buildup of scar tissue underneath the skin in the area just above the tip called the Supra tip. These changes are very common .if they are mostly due to a buildup of scar tissue one or more shots of Cortizone may sometimes be used to dissolve the scar tissue and correct this. If the fullness is the Cartlidge of the dorsal portion of the septum, the only way to correct this would be to reset a small amount of additional dorsal Cartlidge. This is a very common problem and one that often frustrates surgeons as well as patients.

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
From your photos, the development of the deformity in the postoperative views is apparent.
The Polly beak deformity may be caused by the postsurgical gradual resettling of the underlying structural bone and cartilages (most often the septum), or excess scarring in the supratip region.
If due to excessive scarring, steroid injections may soften the tissues. Otherwise, surgical revision may be required after swelling from the previous surgery has completely abated. 15% of cosmetic procedures may require secondary touchup revision.
Revisit your plastic surgeon for evaluation and discussion.
Best wishes...

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