"Polly beak/ supratip fibrosis" 3 years after surgery - How to assure success during revision? (photo)

Right after surgery, the nose was soooo short! With the tip far elevated. It's normal for a tip to fall *some* during the healing process, but nowhere near the amount that your nose fell. Whether the prominence above the tip is a pollybeak or fibrosis can possibly be determined by feeling it. A pollybeak is cartilage left behind -- fibrosis feels softer.
Either way, though, seems to me that the goal on your nose would be, mainly, to lower the prominence above the tip -- whatever it is -- and elevate the tip. Elevate it to a point that you think is attractive, determined by playing with morphs until a good goal is reached.
How to determine whether the doctor has the skill to accomplish it? In an ideal world, the doctor would tell you yes or no he can or can't. Barring that, you go mostly by before and after photos, somewhat by reviews, etc.

Hello and thank you for your question. Based on your photograph, you will benefit from a revision rhinoplasty to help correct the poly beak deformity. This can be accomplished with good surgical technique. Here is some advice on selecting a surgeon for your revision.

I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I always recommend that you carefully evaluate your surgeon’s online before and after gallery on their website for both quality and quantity of results. Make sure that there are hundreds of real before and after pictures which demonstrate long-term follow up results. If your surgeon is posting mostly on table results without real long-term follow up results, that is usually a major red flag. If a surgeon is posting mostly just splint removal day videos without longterm follow-up pictures, that can also be a red flag. Long-term results are much more meaningful than on table results or 1 week post-op results. Selfie’s can also be fun to look at, but these can often have a filter and do not represent true longterm results because of this and are not as valuable as real longterm in-office before and after photographs on your surgeon’s website.

With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon