ANSWER: 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. This nasal deformity can have many causes --- including, from a previous primary rhinoplasty surgery or a revision rhinoplasty surgery --- 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 nasal 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. Revision rhinoplasty is a challenging surgery. Before having revision rhinoplasty, choose your surgeon carefully. Make sure the surgeon is a specialist in rhinoplasty and revision rhinoplasty, such as ABFPRS board-certified facial plastic surgeons. It is also important to find out how many similar procedures the surgeon has performed in the past two to three years.
---- Dr. Kridel, Houston, TX