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

Sometimes, issues like yours can be due to swelling or scar tissue, in which case it would feel soft. In those situations, sometimes a steroid injection might be helpful. If you will indeed require revision rhinoplasty, the key to a successful result would be utilizing structural cartilage grafts to support your tip to prevent it from drooping. I hope this helps, and I wish you well moving forward. Sincerely, Dr Joseph

Thanks Modest794722 for your question! A Polly beak deformity, also known as supratip fibrosis, is a common complication that can occur after rhinoplasty surgery. It has a bird-like look due to a fullness or convexity in the region just above the tip of the nose.
Polly beak deformities come in two primary varieties:


Cartilaginous Polly beak which occurs when there is excess cartilage in the supratip area, and soft tissue Polly beak that occurs when there is excess soft tissue, such as scar tissue, in the supratip area.

A Polly beak malformation can arise as a result of several circumstances, such as:
Insufficient cartilage removal: which is surgeon's failure to remove enough cartilage during the first rhinoplasty.

Formation of scar tissue: The supratip region may develop an excessive amount of scar tissue, giving it a full or convex appearance.
Poor healing: A polly beak deformity can occasionally result from improper healing of the tissues of the nose.
The degree of a polly beak deformity and its underlying cause determine how it should be treated. Steroid injections and other non-surgical procedures may be useful in some situations to lessen convexity or fullness. However, in most cases, revision rhinoplasty is necessary to correct the deformity.
Revision rhinoplasty is a surgical procedure that is performed to correct problems that have developed after a previous rhinoplasty.
A board-certified plastic surgeon with expertise in revision rhinoplasty should be consulted if you are worried about a polly beak deformity. The surgeon will be able to evaluate your particular situation and suggest the best course of action.
As a triple Board-Certified Plastic Surgeon and experienced rhinoplasty surgeon, I specialize in revision rhinoplasty. This complex procedure requires meticulous attention to detail and a deep understanding of facial and nasal anatomy. I am committed to correcting imperfections and restoring both the form and function of the nose. My philospphy is to listen carefully to the goals and desirers of my patients with a focus on patient satisfaction, I utilize advanced techniques to achieve natural-looking and long-lasting results.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

It's pretty reliable to correct for this as long as you have good followup care - I suspect the issue was that you went somewhere abroad so it was harder for you to get in, but you would normally treat this with steroid injections throughout the postop process.

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

Poly Beak can be caused from two different issues which include thickness of the skin in that area call the supra tip, or residual firm cartilage. Residual cartilage must be treated with a revision rhinoplasty, while thick skin is treated with steroid shots. Best to initially follow up with your operative surgeon to see what the issue may be.