Do I have a polly beak deformity? (2 years post op). Options?

Question

I had a rhinoplasty done two years ago and am unhappy with the results. The focus of the procedure was to reduce the dorsal hump, and fix a droopy tip. I feel like I had too much taken off the bridge and and am left with a round unflattering tip. Can someone confirm, do I have what is considered a pollybeak deformity? Pictures attached.

Steven M. Denenberg, MD · Answer

To me, a "polly beak" is when the fullness above the tip is even more pronounced than it is on your nose. What I wonder, in looking at these photos, is whether you are happy with the correction of the "droopy" tip. It could be that the bridge of your nose wasn't over-resected, but rather if the tip of the nose is elevated, and brought a touch back closer to your face, and the fullness above the tip reduced, that might be the goal you're seeking?
The woman in the short video that I posted with this answer had the tip of her nose elevated in her revision operation, though more than your nose would require.How *much* to elevate the tip, or adjust the bridge, and would that "fix" what you're seeing? We figure that out with morphs, well before surgery. I'd love for you to see some excellent professionally-designed morphs of what could possibly be done with your nose. Morphs could also help you identify what's bothering you, and help you set a goal for the rhinoplasty that's accurate for your tastes. Profile and three-quarter views would be particularly important in morphing your nose. (Side note: in my opinion, morphs should always be done by the surgeon, or he should direct an assistant as she makes the morphs. Morphs should be made with a constant eye to what actually *can* be done in surgery, for that particular nose, and only the surgeon has that information and judgment. Another aside: I also recommend that you not show morphs made by one surgeon to a different surgeon. If a surgeon makes his *own* morphs, you get to see whether he understands the important issues of your nose, and how your nose should be changed. But if you show the surgeon someone else's morphs, and he says "Of course I can make your nose look like that," then you don't really know if he fully understands, or even recognizes, the important changes shown in those morphs. And you don't know if he can make those changes during surgery.)
Remember that rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. The changes that your nose needs require advanced techniques, and skill that most plastic surgeons don't possess with expertise. For most noses, it's much better to not have surgery than to have inexpertly-performed surgery. Read my essay on how to stay out of trouble while selecting a rhinoplasty surgeon. And for those who have had previous surgery, it also discusses how to tell whether your first surgeon should be performing your revision. And it also discusses how to take photos that are best for online evaluations.
Your nose is also a perfect example of why computer imaging by the operating surgeon is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. I always email morphs to my online rhinoplasty consultations. When you see the surgeon's goals in the morphs, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are large enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?

Gary Linkov, MD · Answer

Revision rhinoplasty requires exceptional skill on behalf of the surgeon and great communication with the patient about realistic goals and expectations.
Common cosmetic concerns include a dorsal hump, wide nose, sunken nose, irregularities, and asymmetries. Functional concerns include difficulty breathing through the nose, which can and should be addressed at the same time as your rhinoplasty.
In a revision rhinoplasty, cartilage from your septum may have been depleted and therefore often an alternative source of cartilage is needed, such as from the ear. This is just one of the important differences between primary and revision rhinoplasty that need to be discussed in detail before you decide to proceed with surgery. 
In your situation, we would need more standardized photos (closer and more formal views) in order to provide a recommendation. 
Make sure to seek out the care of a board certified surgeon with extensive experience in revision rhinoplasty. Find someone you connect with, who will listen to your concerns and provide you with a framework for what is possible.  
Gary Linkov, MD
Rhinoplasty Specialist
Manhattan

William Portuese, MD · Answer

From the limited photographs, there does not appear  you have a poly-beak deformity.   Much more information is needed, such as a full set of facial photographs especially of your nose, a copy of the operative report.   Before pictures were also be helpful.  Thick skin in the tip of the nose prevents refinement in that area, so that must be determined at time of examination.  Wide cartilages can be reduced, but is very difficult to do anything about thick skin in the nasal tip.

Do I have a polly beak deformity? (2 years post op). Options?

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