Rhinoplasty Question. Had Bump Removed On Left Side of Bridge and Now Have Thickness Above the Tip? (photo)

I had a bump removed on the left side of my nosebridge (see pic 1). It is now almost 7 months post up. I now have a very thick portion just above my tip,I think it is pollybeak deformity, Also i believe that my docter shaved down my nosebridge too much as my side profile looks pretty feminent now. I also believe my right nostrill has become larger as a result of the surgery. Pic 4 basically sums up all the problems i have with my side profile and everything that i want to correct. Should i show him this?

Doctor Answers 6

Dorsal Resection Issues after Rhinoplasty

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    The issue with the dorsum may be remedied if the same issue is present at one year.  With regard to the right nostril issues, this would be impossible to evaluate without preoperative pictures.  Kenneth Hughes, MD Los Angeles, CA

Problems After a Rhinoplasty (Polly beak deformity)

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Thank you for submitting your photographs as this is very helpful in answering your questions. It does indeed look like you have a Polly beak deformity or profile shape where the nose is slightly curved downward like a parrots (hence the term Polly beak). This can have a number causes but in your case it appears to be the result of taking a little too much bone out and leaving a little too much cartilage on the septum. The fix is fairly straight forward but unfortunately involves another surgery, something that all surgeons would like to avoid if possible.

You do have slight nostril asymmetry but at 7 months it is hard to say if this will correct itself or not on the next 5 months and it is hard to say without seeing you in person.

Going forward, make sure you check out your surgeon’s revision rhinoplasty work before you commit to surgery and also make sure you have made you goals very clear to your surgeon.

I hope that helps.

Best regards.

Revision rhinoplasty candidate for poly-beak

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  The photographs demonstrate a polybeak, which can represent thickened skin or excess cartilage left behind from the prior rhinoplasty. There is also columellar show present which can be reduced. In our practice, these type of issues  would be improved with a revision rhinoplasty which includes a cartilage graft to the top part of the bridge, reduction of the lower part of the bridge  where the polybeak is located, reducing the columellar show and possibly placement of the alar rim graft to correct the alar rim notching.

Fixing a Bad Rhinoplasty Requires a Unique Skill Set and Precise Grafting Techniques To Restore A Natural And Beautiful Result

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Unfortunately you are in good company. Most rhinoplasty patients out there are very unhappy with their results in 1-2 years. The explanation for this is very simple: Most surgeons performing rhinoplasty do not have advanced training or experience, they perform the rhinoplasty of 50 years ago. Decades ago thought process of rhinoplasty was to remove cartilage to refine the shape of the nose and perform it through an open approach. An open approach makes it easy for neophyte surgeons to access visualize and manipulate the structures but also unnecessarily destroys two arteries and veins that are important for nasal vascularity. The open approach thus ensures that patients have 1-2 years of risidual swelling which hides the final result. Most rhinoplasties out there I consider cartilage robbing thus when the swlling resolves there is inadequate structure to provide aesthetic appearance and fight the cicatriacial forces or the continued scarring that results from the lowered oxygen tension and fibrosis of tissues. One additional problem it that most rhinoplasty surgeons out there inadvertently break the connection between the bony nose and the cartilagenous nose. this can cause irregular narrowing and what we calll "the inverted V deformity" which means the outline of the nasal bone becomes visible through the skin particularly in flash photography under certain lighting conditions.

In my opinion, an expert level rhinoplasty is always performed in a closed technique and ALWAYS involves grafting to add to the structural integrity of the nose. The act of opening the nose even under the closed technique causes healing and some contraction, thus for a long term beautiful result the nose must be left more structurally sound than it was found. This is missed upon most rhinoplasty surgeons.

In secondary cases such as yours it is even more crucial that sound grafting techniques are used. It sounds like at a minimum you will need bilateral spreader grafts, alar struts and a columellar strut but a complete L-strut should be considered and harvesting a small bit of rib cartilage may be necessary depending on your findings. I Definitely do not consider any rhinoplasty procedure that does not include grafting preferably by an experienced Plastic and reconstructive training with ddition fellowship level craniofacial and aesthetic training. Of course this is my bias because it is my training but I think this level of training is very necessary for success in secondary and tertiary rhinoplasty because there is delicate nuance involved and every patient requires different maneuvers. I hope this helps!

All the best,

Rian A. Maercks M.D.

Revision rhinoplasty issues

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If I were you I would go over my concerns with your surgeon. The nose looks like it was overtreated and may need revision to "build it up."

Revision rhinoplasty for the overdone nose.

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Revision rhinoplasty for the overdone nose in your case involves building up the bridge with your own septal cartilage and correcting your polybeak and adequately supporting your tip. You can see many examples of this on my website under revision rhinoplasty results over the past 35 years.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.