Smoothen Tip Pollybeak and Severe Irregularities?

Hello, I have a nasal result after 2 rhinoplasties, that because of severe width suturing from the primary, has caused an extreme pollybeak and protrusion in the tip that I did not have before. The pollybeak is truly extreme from the side profile, and from the front, it causes severe shine in the cartilage spine, extremely dented contours, and a sickly, surgical look. My birth nose wasn't like this; it was very wide + thick, but smooth. What can be done to restore a smooth look from all angles?

Doctor Answers 10

"Pollybeak", or supratip deformity, is the shape of unsupported nasal skin

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Look at the nasal shape of a young child: it has a low bridge and a blunt, round tip.

That is the shape that any nose will assume on if the nasal skeleton has been reduced below the size that can support and shape the skin.  Amazingly, these noses need to be augmented: because the skin cannot shrink any more, so the skeleton has to be brought up to the skin.  In doing so, the new nose takes on shape and looks more delicate and actually smaller.  Your breathing will actually improve.

This type of surgery is very successful but must be done by someone who performs revisionary rhinoplasty often.  Find a surgeon whom you trust and who can show you results of other patients with similar deformities that you like.  Good luck!

Nashua Plastic Surgeon

Polly Beak deformity can be fixed

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A Polly beak deformity is the appearance of a rounded fullness of the lower third of the nose that obscures any definition of the nasal tip; it can have many causes and therefore there are many different solutions based on the reasons that the Polly beak has formed. (1) If the tip of the nose has lost projection and now has fallen back closer to the face, it will appear as a Polly beak. The solution here is to re-project the tip by giving it more support, usually through the use of a columellar strut and a tip graft. (2) If the roundness is due to there just being too much cartilage left on the lower bridge of the nose near the tip, simple excision can be done. (3)If, however, too much structure(cartilage) under the skin has been removed and the skin is thick, more structure will have to be added back to the nose to put the overlying skin on stretch so it has more definition; cartilage grafts to the bridge and tip may be necessary. (4) Sometimes the lower third of the nose looks relatively too full when too much has been removed from the upper portion of the bridge and then more cartilage needs to be added back. (5) A small soft tissue Polly beak caused by the formation of scar tissue can sometimes be helped with serial steroid injections to shrink the thick skin.

Russell W. H. Kridel, MD
Houston Facial Plastic Surgeon
4.3 out of 5 stars 15 reviews

Polybeak deformity after rhinoplasty surgery

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Polybeak deformity, defined as an overly projected nose, at the junction of the  bridge and tip,  after rhinoplasty can be caused by

  1. Excessive cartilage in the supra tip region:   If this is the case,  shaving down the appropriate amount of cartilage will correct this problem and create a smooth transition between the bridge of the nose and tip.  This must be done in such a way that breathing is not compromised.  If there is a need, where significant reduction was performed, spreader grafts should be placed to maintain support.  These grafts can often create a temporary increase of width to the nose which can take time to resolve, especially in revision cases.  I would not judge the final width for at least 18 months to 2 years post revision.
  2. Excessive soft tissue in the supra tip region possibly from the first surgery.  In thicker skinned patients, there is a tendency for the supra tip region to fill in with scar tissue, negating and refinements made in the this portion of the nose.  This can create a polybeak deformity.  In the initial stages of healing, this polybeak can be injected with steroids melting away the swelling and early scar tissue.  Once fully healed, injections won't help and surgery to remove the scar tissue maybe necessary.  This is why follow up after surgery is so important.  Rhinoplasty surgeons can often identify those at risk for developing a polybeak and treat it non surgically before it becomes permanent.

I am not sure where you fit in.  It would help to send pre and post operative photographs as well as give some more information regarding when when your surgeries were performed.

Good luck

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Correcting pollybeak deformity

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A pollybeak is a very difficult problem to deal with and comes from a variety of reasons.  Thick skin, fluid retention, and excess cartilage are all causes of a pollybeak.  It is important to identify the cause and address the offending issues.  Fluid retention is best treated with simple cortisone injections.  Excess cartilages are treated best by revision rhinoplasty to trim down supra tip area, including both the upper lateral cartilages and lower lateral cartilages.  Excess thick skin can be thinned down with minimal success since it tends to regrow more scar tissue.  Postoperatively cortisone shots will need to be placed in the supra tip area to reduce the recurrence of pollybeak along with Blenderm tape for several months to hold the tip swelling down.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Pollybeak treatment after Rhinoplasty

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Revision rhinoplasty is always difficult as the loss of tissue and the addition of scar will limit the result.  The pollybeak may be the result of inadequate resection or may actually be the result of a tip with poor support pulling down.  The treatment will depend upon the problem - additional resection or cartilage grafting.  You should seek the opinion of an experienced surgeon who can make a recommendation after evaluating you and reviewing your previous records.

Randy J. Buckspan, MD
Austin Plastic Surgeon
4.6 out of 5 stars 10 reviews

Fix Polly beak after Rhinoplasty

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A true Polly beak deformity is caused by an overactive scar tissue response in the tip and supra tip areas of the nose after a Rhinoplasty. It requires a revision Rhinoplasty to remove the excess scar tissue and close follow up with kenalog injections to prevent the scar tissue, and Polly beak from returning. There's no guarantee that it won't come back....even in the best Rhinoplasty surgeons hand.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Non-surgical rhinoplasty (nose job) can be effective for Revision rhinoplasty & treating Pollybeak Deformity

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Polly beak deformity describes a condition in which the tip appears blunted, rounded, and non-defined.  This may be treated with surgical or non-surgical rhinoplasty.  Sometimes, more reduction is needed but more often it is important to add definition to the nasal tip.

If you have a playback deformity it is very important to seek the treatment of a surgeon specializing in revision rhinoplasty as it can be a challenging problem and has the risk of becoming worse.

Non-surgical Rhinoplasty is frequently a good option for individuals who have had incomplete surgical outcomes because it is better at small, fine tuning contours.  While there are still risks of injury with non-surgical rhinoplasty, they are less than the risk of a full surgical procedure.

Good luck in your search for information!

David C. Mabrie, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 157 reviews

Improve pollybeak deformity

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Revision rhinoplasty can be done to correct a pollybeak deformity. Depending on the nature of the other tip irregularities you may need cartialge grafting to improve the contours in that area.

An exam would allow for a better overall assessment.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Pollybeak deformity

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Without an exam or at least photos to review, it is hard to comment as to the possible improvements that can/cannot be offered to you.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Polly beak deformity

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there are some very nice options for correction of the deformity you describe - many involve use of cartilage grafts to reconstruct the bridge

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 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.