How to Reduce the Probability of a Pollybeak Deformity in Primary Rhinoplasty: A Single-Center Experience

Hoehne J, Brandstetter M, Gubisch W, Haack S.

What this paper says

The authors describe two techniques for preventing fullness above the tip in patients with thick skin, reporting a series of 74 patients treated with a modified supratip suture and 21 with direct skin excision over 5 years.

Overview

Pollybeak is fullness in the profile just above the tip that gives a beak-like appearance, and it is described as common and highly stigmatizing after a first rhinoplasty. Thick nasal skin raises the risk. This article sets out two preventive techniques used at the authors' department in at-risk patients.

Sections of note

The deformity is described as very common and highly stigmatizing following primary rhinoplasty.
Patients with thick nasal skin are identified as the at-risk group.
Technique one: the authors' modification of the supratip suture originally described by Guyuron.
Technique two: direct excision of excessive skin, termed supratip excision, reserved for rare cases with massive skin excess.
Case series over a 5-year period: 74 patients treated with the supratip suture technique.
21 patients treated with the supratip excision technique.
The authors state very good aesthetic results are achieved with either technique in selected cases; the abstract gives no rates, measurements, or follow-up.

What it means for a patient

Thick skin above the tip is the main risk factor, and it is addressed during the first operation rather than corrected later.
The usual approach is a stitch; cutting out skin directly is reserved for rare severe cases.
Cutting out skin on the outside of the nose leaves an external scar, which is why it is limited to selected patients.
Limits: single center, no comparison group, no numeric outcomes, and no reported rate of pollybeak in either group.

Why this paper matters

Pollybeak is among the most frequent reasons for revision rhinoplasty, so prevention during the first operation is where it can be reduced. Reporting two graded options with case numbers is useful. Without outcome rates the abstract does not show either technique prevents the deformity.

Terms

Pollybeak deformity: Fullness in the profile just above the nasal tip, resembling a parrot beak.
Supratip: The area of the nose immediately above the tip.
Supratip suture: A stitch placed to hold the skin down against the framework above the tip.
Primary rhinoplasty: A patient's first nose operation.
Skin excess: More skin than the underlying framework requires, which drapes rather than conforms.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Being a very common and highly stigmatizing deformity following primary rhinoplasty, a pollybeak deformity should be avoided during any primary rhinoplasty, especially in patients with thick nasal skin. Two surgical techniques used in the authors' department to decrease the probability of its development in at-risk…”

Excerpt; the full abstract is on PubMed.