POLLYBEAK DEFORMITY

Pollybeak deformity describes a situation in the nose where the tissue above the tip of the nose, the supra-tip area is higher than the tip. It is higher than any other part of the nose. The convexity of this area is what detracts from the most beneficial and aesthetic look of the nose. It has several causes.

This deformity can occur genetically. This is when a person born with it. Bruce Willis is a good example of a pollybeak deformity. I believe he has never had a rhinoplasty so I’m assuming he was born with it.

The creation of pollybeak deformity may occur as a complication of rhinoplasty. And, it may be from several different factors. Originally, the belief was that inadequate resection of the portion of the septum beneath this area was the cause. I have found while revising other doctors’ nose surgeries that this can occur.

I have seen this most commonly with patients who came to me for revision of their open rhinoplasty. This is one of the problems with the open technique. Insofar as the surgeon does not have a moment-to-moment evaluation of the result as he is creating it.

When I perform the closed-rhinoplasty technique, I’m able to see the result as it unfolds in front of me. The average open rhinoplasty technique requires that the skin that has been retracted must be replaced periodically to determine what adjustments need to be made. This deformity can also be the cause of over resection of the dorsum in its entirety.

What happens is that when over resection occurs the thick skin cannot shrink wrap over the new underlying structures that the surgeon creates. Therefore, the tissue bunches up over this area. And, it produces the pollybeak deformity. I believe that the closed-technique lends itself best to preventing this deformity from occurring. I have corrected pollybeak deformities produced by other surgeons in several different ways. This includes the use of banked cartilage to achieve a greater tip projection. Furthermore, in doing so it eliminates the disparity between the tip and the remaining skin.

It is best to avoid pollybeak deformity. However, there is a way to correct it when it occurs if in the right hands. In my opinion, this is done using the closed technique. Remember the best-looking elegant noses have very specific relationships. This must be achieved in order to create the most elegant aesthetic look.