Supratip Swelling After Revision Rhinoplasty, Should I Massage? (photo)

You are very early in the healing phase. I think there are 3 reasons patients get polly beaks:1. The tip is too weak and drops back making the lower part of the bridge appear too high forming a polly beak, this can be seen immediately after surgery or it can develop slowly as a weak tip drops back over time.2. The lower part of the bridge right above tip is left too high forming a hard tissue polly beak.3. Both the lower bridge and the tip are lowered or reduced too much and the skin is loose and in excess and forms a ball or lump of tissue that is a soft tissue polly beak.Any one these could be the reason you are are developing your issue. Only the surgeon has a good chance of predicting where you will end up when the swelling goes down, which can take months. There are many times that I do a rhinoplasty and I set the tip and bridge where the nose looks nice but there is so much swelling during the recovery period it looks like the patient has a polly beak. Since I did the surgery I know how well I set the tip and what it will look like as the edema goes down. In your case, male patient with thicker skin, it will take longer to see your results come through-be patient, it can take months to see results and share your concerns with your surgeon.Good luck and I hope this helps.

Hello, and thank you for your question.  Without a full set of pre-operative images it is a bit difficult to fully answer, but at 13 days you seem to be healing well, and with an acceptable amount of swelling.  From your side image(s), I am hopeful that you will achieve an improved result.My best,Sergio P. Maggi, MD, FACSdrmaggi.com

One of the major steps in correcting a poly beak deformity is establishing a strong tip support.  As long as you have good tip support the polly beak will be improved.  2 weeks post surgery is still very early for you to judge the results of your surgery - be patient and follow up with your surgeon

I read your concern and reviewed your photos:

I would not suggest massaging the area of fullness. If the swelling isn't moving in the right direction over the next 2 weeks, you may want to ask your surgeon if he feels a dilute triamcinolone acetonide (steroid) injection might be suitable for you.

I hope this helps you.

Dr. Joseph

Taping can provide some pressure over the soft tissue swelling and reduce swelling over time.  Steroid injections (must be conservative) can also reduce swelling and decrease the risk of pollybeak. 

Although the pictures are not definitive your issue is not so much swelling (too early to judge) or polly beak. Rather you lack tip projection. The question whether you had a columella or shield graft done. Discuss with your PC and follow his/her advice.

This is something you should review with your surgeon at this stage. If you had the confidence to go for a revision then stick with his or her advice about these early post op maneuvers. 

Time will reduce the amount of swelling you have in your nose.  Generally, you will see a significant reduction in swelling within the first month or so.  Please maintain close communication with your surgeon.

Massage is perfectly reasonable and may assist with healing to a slight degree.  It certainly will not worsen your situation.  13 days is very soon after surgery and currently based on your photo I would expect dramatic improvement over the next few weeks.  If there is any evidence that a pollybeak does recur then you would want to immediately revisit with your surgeon.  At times, a kenalog injection can assist with the problem of excessive scar tissue formation.  Revisional surgery does tend to take a greater deal of time to heal than an initial surgery so be patient but proactive if you notice issues that are not seeming to resolve.  Hang in there!  So far so good.

Follow your surgeon's instructions re the treatment of supratip swelling after surgery to treat a pollybeak deformity. This may include massage as you suggest,  or even Kenalog injections. This should improve.