Do I need a revision? Would fixing the tip resolve my issues?

Question

I had my first rhinoplasty 8 months ago and had A LOT of swelling in my nose. I also had a small collapse in my left nasal valve. I do notice that something looks wrong with it, but I cannot tell if it is a pollybeak or what is wrong. I also have a lot of flaring in my nostrils and was wondering if there was a way to fix that. My doctor wanted to schedule me for just a tiplasty. Would I need a full revision or would fixing the tip resolve my issues.

Barry M. Weintraub, MD, FACS · Answer

Judging from your photos, yours is a tricky case. From the front, you have either prolonged swelling of your nasal tip on your right side (which shows as the left side of the photo), or your lower-lateral cartilages were not trimmed enough, or you developed a Polly beak, which means an excess of scar tissue. If it’s swelling, it will decrease with the passage of time. If it’s excess cartilage, it will not decrease with the passage of time; if it’s a Polly beak (scar tissue), a steroid injection could help. Whatever the reason, this formation gives the impression of a “C” curve from straight-on view. In profile, your tip is blunted and lacks projection. The projection will not increase with the passage of time, and you will likely need a strut to provide proportionate projection. Your ¾ view of your left side of face shows the nose as more bulbous, since the right swelling/cartilage/scar tissue is too prominent and it is most obvious in this view. In my practice, I perform many revision rhinoplasties, and they require a much more experienced skill set than what is needed for a primary (first-time) surgery. Before operating on you, I would try an injection to diagnose the fullness of your lower right cartilages. Six weeks should pass before the results can be properly assessed. Does your original surgeon regularly perform revision rhinoplasties? I would be very careful with this, and not proceed too quickly.

Marc Polacco, MD · Answer

Thank you for your question. I'm sorry you're going through this, but there are ways to address your concerns. Yes, it appears that you have what we call a "pollybeak" deformity. There are a few things that can cause this, including too much left over septal cartilage or scar tissue formation. An exam would be the best way to determine which is occurring, and a tip-plasty would be sufficient to treat it. This area will also continue to get a bit better over time, as this is the area where swelling resolves last. Regarding alar flare, alar reduction would be the best method to address this, which could be performed concurrently with the tip-plasty.

Thomas Trevisani, MD · Answer

Based on photos and description of your issues, you may be a candidate for additional improvement to achieve your intended goal and look. I do not believe that the tiplasty by itself will give you the best result. Remember, when you change one aspect of the nose -all other relationships are changed.

Richard Mark Winters, MD · Answer

Your issues can be addressed by lowering your radix and providing tip projection to fix your ‘polybeak’… a septal extension graft will take care of this….

Do I need a revision? Would fixing the tip resolve my issues?

Answers (4)

Answer: High radix and poor tip projection…

Answer: High radix and poor tip projection…

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Do I need a revision? Would fixing the tip resolve my issues?

Answers (4)

Answer: High radix and poor tip projection…

Answer: High radix and poor tip projection…

Browse related questions

Recommended reading

Everything you need to know about Revision Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.