Background: Rhinoplasty is fundamentally about changing the structural support of the nose to effect an external shape change. But no matter how well the bone and cartilage structural support is changed to look like the desired shape, the overlying skin and how well it adapts to it becomes the arbitrator of the final result. This is well known to be a potential problem in thicker skinned noses as its ability to shrink down and show the full effects of what the reshaped nasal framework looks like is more limited.
One of the most common undesired postoperative nasal tip shape problems is that of the pollybeak deformity. This occurs when there is too much fullness in the supra tip area creating a bulge or fullness. This may or may not push the tip of the nose downward. There are a variety of causes from too much residual septal angle cartilage, nasal tip cartilages that remain too prominent, over resection of the bridge, and excessive scar tissue. And in many cases several of these factors are contributing to its appearance.
Case Study: This female had a prior rhinoplasty of which her result was dissatisfying as she felt her tip was too big and round and droopy.
In a secondary corrective rhinoplasty the septal angle was reduced as well as that of the caudal septum. Extensive scar tissue was also removed and tip reshaping sutures (lateral crural strut) were placed. Prior to closure a thin layer of gel foam soaked in Kenalog 40 was placed in the supra tip area.
Her six month result showed improvement in the tip shape with some additional refinement, less droopiness and an improved supra tip shape.
1) Secondary rhinoplasties are frequently done for a nose that is still too thick or not refined enough, particularly in the tip area.
2) Secondary rhinoplasty typically involves removal of scar tissue and tip reshaping maneuvers to try and create a more refined tip shape.
3) Postoperative 5FU and steroid injections are often essential injection strategies to maximize tip shape.
Dr. Barry Eppley