Do I Have A Pollybeak Deformity After My Rhinoplasty?
Q: Dr. Eppley, I had rhinoplasty two months ago and am worried that I might have a pollybeak deformity? I was given a steroid injection on the supratip from my surgeon a few weeks back. My surgeon is assuring me that the beak-like appearance I am seeing is a result of swelling, but I am concerned that it is left over cartilage that has not been resected all the way. What are your thoughts? Can swelling mimic a pollybeak deformity? For someone with my skin thickness, how quickly can one expect to see a true pollybeak deformity surface? The first steroid injection appeared to have done absolutely nothing aesthetically. Is this normal?
A: You are correct in your assessment that one cause of a pollybeak deformity after rhinoplasty is residual excessive cartilage in the supratip area. In those rhinoplasty patients who had an original dorsal hump taken down, inadequate removal of the cartilaginous portion of the bump (between the nasal bones and the tip) can create excessive cartilage height in the supratip region, giving the tip of the nose a rounded and downturned appearance. (cartilaginous pollybeak deformity) This may be evident right after the splint is taken off but, often due to swelling of the overall nose, may not become evident until weeks to a month later.
A pseudo pollybeak deformity can also occur due to the development of excessive scar tissue in the supratip area. This can develop due to a small fluid collection which can even be unintentionally created by how the tapes and splint were applied right at the time of surgery. This becomes evident as the swelling resolves where, like excessive remaining cartilage, the supratip gets or remains full.
However, the origin of your pollybeak deformity after rhinoplasty is not clear at just two months after surgery. It may very well be swelling and the injections of low dose steroids is reasonable at this point. It takes three weeks to see any result from a steroid injection and their effects are cumulative. It is not a fast fix. Also, how effective they can be is partially dose related.
Dr. Barry Eppley