Pollybeak Deformity
Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon, specialist registration in Otorhinolaryngology, Head & Neck Surgery.
A pollybeak deformity is a recognised complication of rhinoplasty, though it can also occur in patients who have never had surgery. It refers to a characteristic profile appearance in which the supratip area — the region just above the nasal tip — is the most prominent point of the nasal bridge rather than the tip itself, producing a beak-like profile contour.
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What Causes a Pollybeak Deformity?
The causes differ between patients who have and have not previously had rhinoplasty:
In patients who have not had rhinoplasty
A pollybeak profile is typically caused by overgrowth of the caudal (lower) nasal septum or by the shape and position of the nasal tip cartilages — where the tip lacks sufficient projection to rise above the supratip, making the supratip appear disproportionately prominent in profile.
In patients who have had rhinoplasty
The most common causes are insufficient removal of the caudal septum at the time of dorsal reduction (leaving residual cartilage in the supratip), inadequate tip projection relative to the dorsum, or accumulation of scar tissue in the supratip dead space during healing. Scar tissue-related pollybeak deformity is more common in patients with thick skin and tends to develop gradually as healing progresses over the first twelve months after surgery.
Treatment
The treatment depends on the underlying cause:
Residual septal cartilage
Where excess caudal septal cartilage is the cause, targeted removal or reduction of the supratip cartilage through a rhinoplasty approach is performed.
Scar tissue
Where scar tissue accumulation in the supratip is the cause, a period of conservative management with steroid injections is often attempted first. If non-surgical measures are insufficient, surgical excision of the scar tissue through a revision rhinoplasty may be required. It is generally advisable to wait at least twelve months after the primary rhinoplasty before intervening surgically.
Insufficient tip projection
Where the pollybeak is related to inadequate tip projection, the tip is refined and elevated as part of the rhinoplasty correction.
As with all revision rhinoplasty, careful assessment of the cause is essential before planning treatment. Correction of a pollybeak deformity is best performed by a surgeon with experience in revision rhinoplasty, as the anatomy is altered from previous surgery.
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Dr Roth’s Clinical Perspective
Pollybeak deformity is one of the more frequent concerns I see in revision rhinoplasty patients. The cause determines the treatment: residual cartilaginous fullness from insufficient caudal septal trim is a different problem from scar tissue accumulation in a thick-skinned patient, which is different again from inadequate tip projection relative to the dorsum. Getting the diagnosis right before planning revision is essential — operating on the wrong structure produces at best no improvement and at worst a different problem. The twelve-month waiting period before revision is not arbitrary; pollybeak from scar tissue often resolves or stabilises significantly in the first year.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
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Speak with Dr Jason Roth
Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.
Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.
Dr Jason Roth | MBBS, FRACS (ORL-HNS) | MED0001185485
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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