How to Correct Pollybeak Tip Deformity?

A pollybeak is excessive fullness in the supratip (the area above the tip).  There are multiple causes of a pollybeak including excessive scar formation in the supratip and cartilage.  Correction of a pollybeak depends on the underlying cause.  An unsupported nasal tip may require additional support while excessive carilage in the supratip may require excision.

Revision rhinoplasty is highly complex procedure and therefore any revision entertained on your nose should be well thought out and planned.

There  can be many causes for a poly beak after rhinoplasty.  The most common problem is that the cartilage of the bridge has not been sufficiently lowered. If that is the situation in your case, it is a pretty simple revision. The surgeon just needs to shave down the cartilage in the supra tip area.  The problem can also be a result of thick skin on the nasal tip.  In these cases, I have thinned out the skin from the deep surface, along with a few steroid injections in the tip skin after a few months.  I have corrected several poly beak problem with surprisingly simple techniques and much success.  

A polybeak deformity represents an imbalance in the relationship of the nasal tip and the height of the nose/septum just above the tip. While certain types of polybeaks are hard to correct, others can be simpler. Essentially 3 different things can be done to re-establish the correct profile relationship.
In typical rhinoplasties, the goal for the profile is one in which a 1-2mm supratip break or depression is achieved. Men tolerate a straighter supratip, while women often desire more of a break. Polybeaks occur in 3 scenarios:

If the nasal septum is left too high
The area above the tip fills in with scar tissue
If the nasal tip loses height (deprojects)

Patients with thick skin are more at risk for polybeak formation due to the balance between skin weight and cartilage strength. More often than not, the tip will lose projection due to weak cartilage. One way to provide the top with greater height and definition is to do one or more grafts to strengthen it. Another way is to use sutures to narrow it. Simultaneously, 1-2mm of height is often gained.
If the problem is with scar tissue, then steroid injections can sometimes prevent it when used post-operatively. If your surgery was more than 3 months ago, it is unlikely that injections will correct it. Patients with thick skin are also at increased risk for scar formation underneath the skin.
If the septum was left too high, then revision profile reduction may correct the problem. However, if you have already had a revision, then this is probably not the main issue.
Good luck

There are several things that could contribute to the polybeak deformity, including development of scar tissue on the dorsum, excess cartilage, or lack of tip projection. Fixing polybeak nose deformity on a thick-skinned person is difficult, but it can be addressed by an experienced plastic surgeon by a variety of ways.
I recommend that you get a second opinion and ask many questions.

Simple is not a word to describe any surgery, let alone revision surgery. What you describe is an operation routinely done by Revision Rhinoplasty experts.
Therefore, see what the surgeon proposes to do to "fix" the problem. Carefully evaluate whether you think their goals are consistent with yours. You want to make this your LAST surgery on your nose.

A pollybeak can be removed easily if it is caused by excess cartilage on the nose. If the pollybeak is caused by excess skin and fluid retention in the supratip area of the nose, this can be addressed by cortisone injections into the area of the pollybeak to reduce it.

catherinem24,First let's define the term of pollybeak. This is a common term though I have not had any patients use it lately. A pollybeak occurs when the projection of the tip is above the point where it is expected. In a nicely shaped nose the projection of the tip off the bridge is along the line of the nostril rim, and the bridge should be straight . The pollybeak is a hump just above this point giving the tip a rounded downward curved appearance also called a ram's tip. Some also refer to the shape as a supratip which is the term used by most today.There are chapters written on the causes of a supratip in rhinoplasty and thick skin is one of them. As the bridge of the nose is reduced the skin can bunch just above the tip and produce this result. Other common causes are overreduction of the bridge of the nose, or excess fullness or projection of the lower cartilages in the nose.Supratips can be corrected, however the cause must be identified and the plan be a sound one. In your case you may need the bridge of the nose raised, or possibly the supratip may be correctable by thinning the tissue above the tip. With skill and judgment a good result is at hand, a simple solution, not likey.Choose your surgeon carefully, and I suggest computer imaging to help guide you to your expected result.Best of luck,peterejohnsonmd

Rhinoplasty is a most challenging surgery especially in someone with thick nasal tip skin. All patients are different, but in general, a pollybeak tip generally needs to be addressed as an open rhinoplasty and have redundant cartilage excised and suture stabilization of the tip performed at the very least.
This is not always simple and should only be done by a surgeon very experienced in rhinoplasty and revision rhinoplasty. The more surgeries on your nose you have, the worse it looks in almost all instances so you want to fix this with only one more surgery. Therefore, it needs to be done by an excellent and experienced surgeon. There is a difference between doctors in this regard for sure.