Pollybeak Deformity and Revision Rhinoplasty: Understanding the Connection

By Dr. Scott J Turner, Specialist Plastic Surgeon

Last Updated May 2025

Achieving an aesthetically pleasing nasal profile is a key goal for patients undergoing rhinoplasty. However, like any surgical procedure, rhinoplasty can sometimes lead to complications that require correction. One of the most common complications is known as a “Pollybeak Deformity,” which represents a significant reason for patient dissatisfaction and revision surgery.

At Dr. Scott J Turner’s plastic surgery clinics in Manly and Double Bay, we believe patient education is crucial for making informed decisions about surgical procedures. This comprehensive guide will explain what pollybeak deformity is, why it occurs, how it can be prevented, and the treatment options available for correction.

What is a Pollybeak Deformity?

Pollybeak Deformity, also known as supratip deformity, is characterised by excessive fullness in the area just above the nasal tip (the supratip region). This creates a distinctive profile resembling a parrot’s beak—hence the name “pollybeak”—where the supratip becomes the highest point of the nose rather than the tip itself. This unnatural contour disrupts the smooth transition from the nasal bridge to the tip that is considered aesthetically ideal in rhinoplasty.

The deformity is not merely a structural anomaly but can be a considerable cosmetic concern with potential psychological impact, often leading to significant patient dissatisfaction. While most pollybeak deformities develop following rhinoplasty (acquired iatrogenically), they can occasionally be present as a natural nasal feature.

Incidence and Significance

Pollybeak deformity is one of the most common reasons patients seek revision rhinoplasty. Research indicates it accounts for approximately:

• 50% of all revision rhinoplasty cases
• Up to 64% of patients presenting for secondary nasal surgery in some studies
• Higher prevalence (approximately 62%) in certain ethnic populations, particularly Middle Eastern patients

These statistics highlight the significant impact of this deformity and emphasize the importance of both prevention and effective correction techniques.

Types of Pollybeak Deformity

Pollybeak deformities can be classified into two main types, each requiring different approaches for correction:

1. Cartilaginous Pollybeak Deformity

This type occurs when there is excess cartilage remaining in the supratip area after rhinoplasty. Contributing factors include:

• Incomplete removal of a dorsal hump during the initial surgery
• Inadequate reduction of the cartilaginous dorsal septum (particularly the anterior septal angle)
• Failure to address the entire length of the nose during hump removal
• Imbalanced reduction of the bony dorsum relative to the cartilaginous dorsum

2. Soft Tissue Pollybeak Deformity

This type is caused by excessive soft tissue or scarring in the supratip area, commonly seen in patients with thicker skin. Causes include:

• Excessive scar tissue formation during healing, particularly in the “dead space” between the skin and underlying framework
• Poor skin re-draping over the new underlying structure
• Aggressive dorsal hump removal without accounting for skin thickness
• Inadequate compression of soft tissues during the healing process

Some patients may present with a combination of both types, requiring a comprehensive approach to correction.

Why Does Pollybeak Deformity Occur?

Several factors can contribute to the development of a pollybeak deformity following rhinoplasty:

1. Surgical Technique Issues:
   • Inadequate resection of cartilage or bone in the supratip area
   • Over-resection of the bony dorsum without appropriately addressing the cartilaginous dorsum
   • Poor management of a “tension tip” (strong, prominent nasal tip)
2. Excessive Scar Tissue:
   • Particularly in patients with thick skin, improper healing can lead to scar tissue accumulation in the supratip region
   • Studies have identified excessive supratip scarring as the leading cause in up to 48% of pollybeak cases
3. Loss of Tip Support:
   • If structures supporting the nasal tip are weakened without adequate reinforcement (through grafts or sutures)
   • Tip support loss can cause the tip to gradually drop, making the supratip area appear more prominent
   • Research shows insufficient tip support causes pollybeak deformity in approximately 28% of cases
4. Patient-Specific Factors:
   • Skin thickness (thick nasal skin significantly increases risk)
   • Ethnicity (Middle Eastern, Asian, and African American patients may have anatomical predispositions)
   • Quality and strength of nasal cartilages
   • Healing characteristics and tendency for scar formation
5. Imbalanced Framework Modification:
   • Over-resection of the bony bridge (approximately 24% of cases) creating an imbalance
   • Creating dead space between the skin and underlying cartilage framework

Diagnosis and Timing

Identifying a true pollybeak deformity requires experienced evaluation. The diagnosis is primarily clinical, established through careful visual inspection of the nasal profile and palpation of the nasal dorsum and tip. Palpation helps differentiate between:

• A firm, cartilaginous fullness (suggesting a cartilaginous cause)
• A softer, more compressible fullness (indicating soft tissue or scar-related issues)

While the deformity may become apparent as early as 1-2 months after surgery, definitive diagnosis is typically made 3-6 months post-procedure when most of the initial swelling has subsided. However, many surgeons advocate waiting for a full year before making critical assessments of nasal contours, as subtle healing and tissue contracture can continue for this duration, especially in patients with thick skin.

This creates a period of diagnostic uncertainty, particularly between 3-12 months post-surgery, when patients may notice concerning fullness while surgeons advise patience. Clear communication regarding expected healing timelines is essential during this period.

Dr Scott J Turner, Specialist Plastic Surgeon, carefully evaluates each patient’s nasal profile during follow-up appointments to distinguish between normal post-surgical swelling and actual structural issues that may require revision.

Prevention of Pollybeak Deformity

At Dr. Turner’s clinics, we emphasise prevention through careful surgical planning and technique:

Preoperative Assessment and Planning

1. Thorough Preoperative Evaluation: Identifying risk factors before surgery is crucial. This includes:
   • Assessment of skin thickness (patients with thick skin require special consideration)
   • Evaluation of cartilage strength and morphology
   • Analysis of existing nasal proportions
   • Consideration of ethnic anatomical variations
2. Systematic Facial Analysis: Understanding how nasal changes will harmonize with other facial features.
3. Risk Stratification: Recognizing patients at higher risk for pollybeak deformity:
   • Those with thick, sebaceous skin
   • Patients with specific ethnic backgrounds (Middle Eastern, Asian, African American)
   • Individuals with deep nasofrontal angles, predominantly cartilaginous dorsal humps, or underprojected nasal tips

Key Intraoperative Techniques

1. Precise Cartilaginous Framework Management:
   • Ensuring balanced reduction of both bony and cartilaginous dorsum
   • Appropriate reduction of the anterior septal angle
   • Conservative resection in thick-skinned patients
   • Maintaining a minimum 2mm differential between supratip and tip projection
2. Robust Tip Support Establishment:
   • Columellar strut grafts to provide foundational support
   • Tip grafts for refinement and projection where needed
   • Septal extension grafts for long-term stability
   • Strategic suturing techniques to secure the desired tip position
3. Dead Space Management:
   • Techniques to minimize potential space between the reduced framework and overlying skin
   • Advancement suturing of soft tissues
   • Specialized supratip sutures to control skin redraping
4. Soft Tissue Handling:
   • Preservation of key ligamentous structures when possible
   • Careful dissection in appropriate planes
   • Avoidance of excessive undermining in thick-skinned patients
5. Preventative Maneuvers:
   • External supratip sutures in high-risk patients
   • Specific supratip-defining techniques for thick-skinned patients
   • Maintenance of appropriate anatomical relationships, especially between the tip and supratip

Postoperative Care

1. Vigilant Monitoring: Regular follow-up appointments to track healing.
2. Proper Taping and Splinting: Specialised techniques to compress the soft tissue envelope against the underlying framework.
3. Early Intervention: Prompt use of corticosteroid injections if early signs of supratip fullness develop.

Treatment Options for Pollybeak Deformity

Non-Surgical Options for Mild Cases

In select cases, particularly for mild deformities or those predominantly caused by soft tissue issues, non-surgical interventions may be considered:

1. Corticosteroid Injections: Triamcinolone acetonide injections directly into the supratip area can effectively reduce fullness in mild cases attributed to soft tissue swelling or early scar tissue. Multiple sessions spaced several weeks apart may be necessary.
2. Injectables: Hyaluronic acid-based fillers can be used to camouflage mild pollybeak deformities by injecting into the area of the bony dorsum just above the pollybeak to create a more balanced profile. This is a temporary solution requiring maintenance treatments.
3. Therapeutic Taping: In the early post-operative period, specialised taping techniques may help sculpt healing tissue and encourage proper soft tissue adaptation.

Revision Rhinoplasty for Definitive Correction

When a pollybeak deformity is confirmed and significant enough to warrant surgical intervention, revision rhinoplasty is usually the most effective treatment option. This secondary procedure is specifically tailored to address the underlying causes of the deformity.

Surgical Approaches for Correction

The approach to correction depends on the specific type and cause of the deformity:

For Cartilaginous Pollybeak

• Precise removal of excess septal cartilage in the supratip region, particularly focusing on the anterior septal angle
• Refinement of the dorsal septum to create a natural dorsal aesthetic line
• Adjustment of the nasal tip position to achieve proper projection and rotation
• Balanced recontouring of both the bony and cartilaginous dorsum to create harmony

For Soft Tissue Pollybeak

• Excision of excess scar tissue in the supratip area
• In early or mild cases, steroid injections (triamcinolone acetonide) to reduce tissue inflammation
• Creation of adequate structural support to prevent recurrence
• Techniques to ensure proper skin re-draping over the new structure
• In select cases with very thick skin, direct excision of fat and superficial musculoaponeurotic system (SMAS) in the supratip region

Dr. Turner utilizes specialized techniques for managing thick skin during rhinoplasty to minimize the risk of pollybeak deformity and ensure optimal aesthetic outcomes.

Special Considerations in Ethnic Rhinoplasty

Ethnic background significantly influences nasal anatomy and can predispose certain patients to pollybeak deformity. Understanding these variations is crucial for both prevention and correction:

Middle Eastern Noses

Patients of Middle Eastern descent often present with:

• Thick nasal skin
• Strong underlying cartilaginous framework
• Tendency for significant postoperative scar formation
• Underprojected nasal tip with poor intrinsic support
• High anterior septal angle

These characteristics can contribute to pollybeak development. Studies suggest that many Middle Eastern patients requiring revision rhinoplasty present with pollybeak deformity. Prevention and correction focus on establishing robust tip support, conservative dorsal reduction, and proactive management of the thick skin.

Asian Noses

Common features include:

• Thicker skin with less natural contractility
• Weaker and smaller nasal cartilages
• Less defined natural supratip break
• Low radix or dorsum often requiring augmentation

These characteristics require specialized techniques focused on strengthening tip support and achieving balanced augmentation rather than reduction. Septal extension grafts and other structural reinforcements are frequently necessary.

African American Noses

Typical characteristics include:

• Thick, sebaceous skin
• Wide and often underprojected nasal tip
• Softer, less rigid cartilages
• Wider alar base

Management focuses on strengthening and projecting the nasal tip through significant cartilage grafting, refining tip definition, and ensuring the framework adequately supports the substantial soft tissue envelope.

Dr. Turner’s approach to ethnic rhinoplasty is always individualized, respecting the patient’s unique anatomy while achieving aesthetically pleasing results within their ethnic context.

Why Choose Dr. Turner for Revision Rhinoplasty?

Revision rhinoplasty, especially for conditions like pollybeak deformity, requires a surgeon with:

• Specialized training and extensive experience in both primary and revision nasal surgery
• Deep understanding of nasal anatomy and the complex healing patterns
• Technical skill to navigate through scarred and previously altered tissue planes
• Artistic vision to achieve natural-looking results that complement facial features
• Expertise in the full spectrum of rhinoplasty techniques, from traditional reduction approaches to complex grafting and reconstruction

Dr. Scott J Turner, Specialist Plastic Surgeon, brings comprehensive experience in both primary and revision rhinoplasty to help patients achieve the natural, harmonious nasal profile they desire. His approach combines technical precision with artistic sensibility, ensuring that each revision rhinoplasty is tailored to the individual patient’s unique anatomy and aesthetic goals.

Contact Us

To learn more about revision rhinoplasty for pollybeak deformity or to schedule a consultation with Dr. Turner, please contact us at our Sydney clinics. Our team is committed to providing you with the information, care, and results you deserve.

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Dr. Scott J Turner is a Specialist Plastic Surgeon in Sydney, Australia, with clinics in Manly and Double Bay. This article is intended for informational purposes only and does not replace a personal consultation with a qualified medical professional.