How do you avoid pollybeak, breathing issues and the need for a revision rhinoplasty?

Question

As a doctor, how do you avoid the following during primary rhino?: 1). Pollybeak deformity 2). Breathing issues that can come up in the future 3). The need for revision rhinoplasty? I would love to go in once and have it done without needing to go back for breathing issues or polly beak. I'm interested in shaving down a hump on my nose that is very slight, making a slight curve to my profile, and thinning nose down. Not sure if this exacerbates any of the issues above.

Ronald J. Edelson, MD · Answer

Good question! A Polly beak is almost always from failure to lower to bridge all the way out to the tip. If the bridge is only lowered in the upper part of the nose you are more likely to see a Polly beak. Unfortunately this is a common mistake in rhinoplasty which can be avoided in most cases.

Tanveer Janjua, MD · Answer

The best way to avoid complications is through conservative surgery. The amounts of cartilage removed should be kept to a minimum and regular followup after surgery should be done to ensure the pollybeak does not happen. It can be prevented with steroid injections and splinting the nose.RegardsDr.J

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. The key to avoiding all of the issues you mention is with cartilage grafts to provide strong structural support for the nose and careful selection of your surgeon. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and not just a computer animation system. You should be able to view numerous pictures of actual patients with noses similar to yours performed by your surgeon. If you cannot find enough real before and after pictures, then consider continuing your search for a surgeon.Best wishes and good luck.

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon

William Portuese, MD · Answer

Even the most experienced surgeons require a 10 to 20% touch up rate.  There is no perfect nose, just improvements, therefore it's very important to have realistic expectations. It's also important to evaluate the internal portion of the nose  to  make sure you don't have any pre-existing issues such as turbinate hypertrophy, valve collapse,  vestibular stenosis, chronic sinusitis, allergies, and   turbinate hypertrophy which can all cause nasal obstruction. The polybeak is prevented with repetitive steroid shots for the first several months after the procedure. That's why the follow-up appointments are just as important as the surgery itself to prevent the polybeak deformity from occurring because of the thick skin present.

How do you avoid pollybeak, breathing issues and the need for a revision rhinoplasty?

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