Revision rhinoplasty in ethnic patients: pollybeak deformity and persistent bulbous tip

Overview

A pollybeak is fullness above the tip that makes the profile curve like a bird's beak, and it is described in the abstract as the most common complication of rhinoplasty, reported in up to 50 percent of cases in some series. A tip that stays bulbous after a first operation is also common. Both are frequent reasons patients return for revision. The authors reviewed their own revision cases.

Sections of note

• Retrospective review of 28 revision rhinoplasty cases in ethnic patients.
• The most common indications for revision were pollybeak deformity and persistent bulbous tip.
• A majority of the deformities were attributed to poor implant selection and placement at the earlier surgery.
• Treatment was often removal of the existing grafts and replacement with custom carved silicone implants.
• Results are described as desirable aesthetic outcomes, without a satisfaction rate or grading scale.
• No follow-up length, complication rate or re-revision rate is reported in the abstract.

What it means for a patient

• The two problems that most often send patients back for a second operation are fullness above the tip and a tip that was never adequately refined.
• In this series the cause was usually the implant chosen and where it was placed at the first operation, not the patient's anatomy.
• Twenty-eight cases from one practice is a small series with no comparison group and no numeric outcomes.
• Silicone implants carry their own long term risks, and none are reported here.

Why this paper matters

It locates the source of these revisions in decisions made at the first surgery, which is a claim about technique rather than about patients. What remains unanswered is how the replacement implants perform over time and whether an approach using the patient's own cartilage would do better.

Terms

• Pollybeak deformity: fullness just above the tip that curves the profile like a beak.
• Bulbous tip: a rounded tip lacking defined highlights.
• Revision rhinoplasty: a second or later operation to correct an earlier result.
• Silicone implant: a solid synthetic implant used to build up the nose.
• Custom carved: shaped by the surgeon during the operation to fit the individual nose.