The Pollybeak deformity is one of the most common complications of rhinoplasty.1-3 It is a convexity of the nasal supratip relative to the rest of the nose. This deformity is colloquially known as polybeak because the lower two thirds of the nose takes on the convex profile of a parrot´s beak. The pollybeak is not due to transient postoperative edema but represents a persistent, unattractive fullness that distorts the dorsal profile and obscures the tip.
While the pollybeak may be the result of technique, it may also be an unpredictable complication for even the most esperienced surgeons. The causes of pollybeak include inadequate resection of supratip structures, most commonly the dorsal septal cartilage or the cephalic margins of the lower lateral cartilages; loss of tip support; or, paradoxically, excesive cartilage resection in the supratip regioon that results in subcutaneous scar tissue formation often in conjuction with thick nasal tip skin.1-5 If excess cartilage is the cause, the condition is called a cartilaginous pollybeak, and simple trimming of this cartilage will solve the problem. With loss of tip support, a cartilage strut or tip graft can be placed to correct or disguise the deformity.
A more difficult problem is the polybeak eformity that occurs paradoxically as a result of the overresection of the lower dorsal cartilaginous septum and/or the cephalic margins of the lower lateral cartilages in the area of the supratip. This deformity usually occurs in combination with thick nasal skin, ressulting in inadequate skin contraction and excessive dead space between the skin and the septal border, wich fills with scar tissue and results in a supratip fullness. The patient who requires revision rhinoplasty with major alar and septal cartilage resections to correct a cartilaginous pollybeak deformity is also at risk for formation of dead space that may fill with scar tissue and result in a soft tissue pollybeak.1
For this soft tissue type of pollybeak, revision rhinoplasty with resection of the scar and debulking of the supratip subcutaneous tissue is often followed by taping and splinting to prevent recurrence. However, this technique may be ineffective in thick-skinned individuals ad must be performed with utmost care so as not to perforate through the skin or desvacularize the dermis from below and cause tissue necrosis. Many rhinoplastic surgeons have succesfully been able to avoid such revision surgery by sequential injection of the corticosteroid triamcinolone acetonide into the supratip scar tissue.6-10 The literature, however, contains only brief mention of the use triamcinolone, and to date there has been little comparision or quantification of the tratment regimens used by vaious surgeons.
