Polly Beak Deformity in Rhinoplasty Workup

  • Author: Henry Daniel Sandel IV, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Mar 22, 2012
 

Other Tests

  • Perform photographic analysis of the face and nose before repairing the deformity.
    • Standard photographs of the face for rhinoplasty include frontal, submental, lateral, and oblique views. Obtain the lateral and oblique view from both sides.
    • Align the patient's head with the Frankfurt horizontal plane when taking photographs of all views except with the view of the submental vertex.
    • Assess dynamic muscular input from the depressor septi nasi muscle with a lateral smiling view. The action of this muscle may yield a dynamic nasal-tip ptosis.
  • Video or digital computer imaging may be helpful in discussing the procedure and its goals with the patient. The images can be adjusted to illustrate the potential changes.
  • Palpate the nose.
    • Tip support is determined by depressing the domes of the lower lateral cartilages toward the posterior septal angle. The degree of depression and recoil are assessed.
    • Supratip scar is assessed by palpation. Palpation of the nasal dorsum distinguishes cartilaginous excess from scar tissue excess.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Henry Daniel Sandel IV, MD  Medical Director, The Sandel Center for Facial Plastic Surgery; Consulting Physician, Facial Plastic Surgery, Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital; Consulting Physician, Department of Facial Plastic Surgery, Anne Arundel Medical Center

Henry Daniel Sandel IV, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer P Porter, MD  Assistant Professor, Department of Otorhinolaryngology, Division of Communicative Science, Chevy Chase Facial Plastic Surgery

Jennifer P Porter, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel G Becker, MD  Assistant Professor, Department of Otorhinolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Pennsylvania School of Medicine

Daniel G Becker, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

References

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  2. Harsha BC. Complications of rhinoplasty. Oral Maxillofac Surg Clin North Am. Feb 2009;21(1):81-9, vi. [Medline].

  3. Christophel JJ, Park SS. Complications in rhinoplasty. Facial Plast Surg Clin North Am. Feb 2009;17(1):145-56, vii. [Medline].

  4. Arslan E, Gencel E, Pekedis O. Reverse Nasal SMAS-Perichondrium Flap to Avoid Supratip Deformity in Rhinoplasty. Aesthetic Plast Surg. Sep 23 2011;[Medline].

  5. Botti G. Thick skin and cosmetic surgery of the nasal tip: how to avoid the cutaneous polly beak. Aesthetic Plast Surg. Sep-Oct 1996;20(5):421-7. [Medline].

  6. Conrad K, Yoskovitch A. The use of fibrin glue in the correction of pollybeak deformity: a preliminary report. Arch Facial Plast Surg. Nov-Dec 2003;5(6):522-7. [Medline].

  7. Foda HM. Rhinoplasty for the multiply revised nose. Am J Otolaryngol. Jan-Feb 2005;26(1):28-34. [Medline].

  8. Hanasono MM, Kridel RW, Pastorek NJ, et al. Correction of the soft tissue pollybeak using triamcinolone injection. Arch Facial Plast Surg. Jan-Mar 2002;4(1):26-30; discussion 31. [Medline].

  9. Johnson CM, Toriumi DM. Open Structure Rhinoplasty. Philadelphia, Pa:. WB Saunders;1990:114-8.

  10. Shafir R, Cohen M, Gur E. Blindness as a complication of subcutaneous nasal steroid injection. Plast Reconstr Surg. Sep 1999;104(4):1180-2; discussion 1183-4. [Medline].

  11. Tardy ME. Rhinoplasty: The Art and the Science. Philadelphia, Pa:. WB Saunders;1997:217-18, 286-7, 798-9, 832-3.

  12. Tardy ME Jr, Kron TK, Younger R, Key M. The cartilaginous pollybeak: etiology, prevention, and treatment. Facial Plast Surg. Winter 1989;6(2):113-20. [Medline].

 
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Supratip (arrow) and tip-defining point (cross).
The nose can be divided into horizontal thirds; the upper third being bony and the lower two thirds being cartilaginous.
The supratip region is an area of thick skin.
 
 
 
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