I had a closed Rhinoplasty a little less than three months ago. Am I Developing a Polly Beak Deformity?
Could this just be swelling or is it really the beginning of a polly-beak deformity? Also, am I helping or hurting by applying pressure and massaging?
Doctor Answers 8
The fact that you can temporarily decrease this swelling above your tip with pressure is encouraging. Minute injections of steroids will frequenty correct the suprtip fullness.
Supratip fullness, commonly referred to as a “pollybeak” deformity, is a postoperative complication of rhinoplasty in which the nasal supratip assumes a convex shape in relation to the nasal dorsum. The “pollybeak” most often results from either inadequate resection of the lower dorsal septum and upper lateral cartilages or, paradoxically, from over resection of these supratip structures with subsequent scar tissue formation in the resulting dead-space.
If you return to see your surgeon or seek the advice of a rhinoplasty specialist. If the appearance of a polly-peak deformity is due to excess scar tissue formation in the tip, steroid injections into that area combined with compressive tape can often improve the appearance.
Polly-beak deformity due to swelling
Swelling can continue for several months after rhinoplasty. One reason for a "polly-beak" deformity is due to swelling above the nasal tip that can permanently affect the nasal contour. Your rhinoplasty surgeon may be able to help encourage the healing in the right direction with a couple of options...it may be helpful to apply 1/2 inch paper tape across this area above your tip to minimize the swelling that can lead to permanent fullness there. Another option would be an injection of steroid to this area, to help flatten the swelling.
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It is understandable that you are concerned especially with the supratip fullness you are experiencing. Changes after rhinoplasties vary with every patient and what you are experiencing is normal especially that swelling takes time to subside as it masks the results of your surgery.
Without a physical exam, it is not possible to provide you with a definitive answer. Nonetheless, the fact that you are able to resolve it with pressure application is promising. Discussing steroid injections with your surgeon may be a good idea at this point.
It is important to keep in mind that it is early to pass a judgment. Usually, a year is required before formulating how your nose will be, but longer with a thick skin. Even then, your nose will keep shaping itself to complement your face for better results in the years to come.
There is no doubt that once the swelling resolves, more definition and shape will be achieved and you should be happier with the results. It is important to keep communicating with your surgeon and work as a team together to achieve the best results possible.
Congratulations on your surgery and please remain positive!
Ali Sajjadian, MD FACS
Pollybeak deformities are the most common complication of rhinoplasty. There are several causes of pollybeak deformity. In your case it sound like the soft tissue envelope of the supra-tip area is not adhering to the underlying tissue. Massaging and pressure may help resolve this problem. If you still have the pollybeak 3 months postop you can consider steroid injections to soften the supra-tip area and/or eliminate any scar tissue. You may also consider other causes of pollybeak deformity including over-resection of the bony dorsum and under-rescection of the caudal septal cartilage and/or persistent soft tissue in the supra-tip area.
There are several methods for fixing a pollybeak deformity most of them surgical.
Polly Beak Deformity
Swelling can continue in the nose for up to 6-12 months after a rhinoplasty. The supratip area is a common place for the swelling to remain and the tip of the nose in general takes the longest to reveal its final shape. The “pollybeak” deformity can result from inadequate removal of tissue in this area, excessive removal of tip supporting elements or just simple swelling in the supratip area. If the contour of the nose improves with pressure it is optimistic to believe that you will get improvement over time. If the appearance of a pollybeak deformity is due to stubborn swelling in the supratip area, dilute steroid injections combined with nightly compressive taping can often improve the nose’s appearance.
Swelling Early in Supratip Area
Swelling two months in the supratip area should not be as much of a concern based on how much swelling is present. Discuss with your surgeon ways to minimize the swelling.
Tough case, but it sounds like you've done your research (for you to be familiar with this term).
Two things, first - remember that your true end result isn't visible for about 6 months. This is why we delay revisions for a year. That being said if you clearly are seeing something then you clearly should do something. I'm with you on that...
For poly-beak deformities your plastic surgeon can inject a steroid into the area to decrease swelling and scar reaction that could be the cause of this right sided bump. It sounds like it's not your caudal septum since it improves with massage. In fact, it sounds like when you massage it - there is a pretty good temporary resolution of it so it is likely not poorly sculpted cartilage underneath but an accumulation of collagen formation and edema. Massage is a good option but be careful to not to disturb his rhinoplasty work. Make sure your plastic surgeon is ok with you massaging there.