Polly beak deformity: from thick skin, scar tissue, elevated bridge, drooping cartilage, or all? (Photo)

You are indeed a candidate for revision, it is unclear what may exist inside, what are the unrelying reasons for your problems or which anatomical parts are ok or which need restoration or replacement, and this uncertainty of preop diagnosis (in your particular case) is due to the combination of a very thick skin (does not allow visualization of inner situation) and the massive amount of fibrosis (not a good sign).
You need a very well expenrienced and very self confident revision rhinoplasty reputed specialist with a wide range of technical resources, and a lot of improvisation and creativity skill since the final diagnosis, planning and strategy decision-making will not occur until intraoperatively he may visualize the real situation underneath the skin.So far seems the tip needs a lot of work, grafting, rebuild, etc, and also the alae show some issues; the dorsum is too broad.
Do research well.

 You need a revision rhinoplasty to correct insufficient tip projection, probably excess scar or cartilage above the tip, insufficient rim cartilage, etc. An in person examination will determine exactly what other issues including the dent need to be repaired. See a very experienced revision rhinoplasty specialist can show you many examples of his work with natural results in noses like yours. 

It's impossible to say for sure which factors are at play, however, it is certainly possible and safe to improve your nose with additional surgery. The most important thing, by far, is your relationship with your surgeon. If you trust them and their abilities then go for it. Otherwise, seek out a revision rhinoplasty specialist even if it means you will have to pay. Good luck!

Dear Tinelillian in Santa Barbara, California:
It is hard to say whether or not the tip rounded and dropped a little bit because of lack of support or due to the fact that, in some people with thick skin, as the tip narrows spontaneously in the healing period the skin thickens up.  A very experienced surgeon should be able to tell the difference and it is possible that by injecting some cortisone or steroid that it can help solve the problem, because if the skin has become thicker that is the antidote to that problem in many cases.  The time to do it is now, because 14 months after surgery has been enough time for the skin to “ripen” and for the result to be visible.  Whether or not lowering your bridge will help is hard to say without feeling the bridge.

 Consult with a surgeon who has long experience, is highly specialized and focused on rhinoplasty,  and has a huge photo gallery so you can find results of patients who had problems similar to yours.  Be sure to bring a written list of questions.  Bring all of your photographs and operative reports from your prior surgeon.   Bring a friend or family member to also listen and observed.  his will make it a much more productive consultation.  Before you go, look at a lot of websites, read the reviews, read books, and learn as much as you can.  You want to do it right the second time and, hopefully, you maybe will have improvement without surgery.

     Best wishes,

Robert Kotler, MD, FACS

Over 4,500 nasal procedures performed

  A poly-beak deformity can be caused by all of the above reasons.  A thorough examination is required to make a determination about what the cause is.  When you have identified the cause,  then a plan for correction can occur.  A revision rhinoplasty is more difficult than a primary rhinoplasty due to scar tissue and thick skin present and alterations of the normal anatomy.  If the issue is excess thick skin, steroid shots  should be  beneficial.  If there is residual cartilage present  in the lower portion of the nasal dorsum, a touch up revision procedure can be performed.

Hello and thank you for your question.  You need to see a true rhinoplasty specialist and this is very different than a Plastic Surgeon who does all surgical procedures.  Do your homework and see people who specialize in nasal surgery.  Your results can be perfectly explained by examining your nose and reading through the previous operative report.  I do this for all my revision patients.  If the doctor cannot explain what happened and how he/she is going to fix it, seek help elsewhere.Good luck,Aaron Kosins, MD
Plastic & Rhinoplasty Surgeon

To render an educated opinion about your current nasal situation, you would need to have a complete evaluation in person, examination, review of medical records, photos and operative reports to try to understand what happened. Thick skin maybe one factor, but I share your concerns and feel that there is room to safely improve tip support, concavity right tip, and fullness in the infra-tip lobule, supra-tip appearance. With more information, a trusted revision rhinoplasty surgeon should be able to recommend the best revision plan to correct your nose. The exact cause may never be completely understood however. Most importantly, do you feel that your surgeon understands and has the best plan for revision? Is your surgeon planning an open or closed revision? Do you have confidence and trust in your doctor's ability to improve your appearance, whether it is free or not? If so, it seems reasonable to proceed. If not, getting another opinion may clarify to you the best path forward. Take your time to explore your options. Best wishes.