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Polly-beak deformity

A polly-beak is fullness in the strip of nose just above the tip, so that in profile the bridge runs level or convex into the tip instead of dipping and then rising. The outline is a parrot's beak, which is where the name comes from. It is the commonest reason a rhinoplasty is done again, and in the largest series on file it was present in 62% of revision patients.

What repeats

Four findings that hold across the series.

It has four causes, and they need different operations

The same 1,160-patient series counted them: an under-projected tip with poor support in 490 patients (68%), excessive supratip scarring in 259 (36%), an over-resected bony dorsum in 202 (28%), and a high anterior septal angle in 173 (24%). Most noses had more than one cause, so the four counts overlap. A polly-beak caused by a dropped tip is a support problem; one caused by scar is a healing problem; one caused by cartilage left too high is a resection problem. Operating on the wrong one leaves it.

Rests on: Hussein et al..

Pitanguy's ligament is the structure the recent work is about

The band running from the dorsum to the tip through the soft tissue turns out to control the depth of the supratip break. Across 120 patients in three groups of 40, ligament untouched, excised, or sutured to the highest point of the caudal septum, the excision group was the one whose supratip depth changed significantly between three and twelve months. In dorsal preservation the finding runs the other way: transecting the ligament prevented the supratip depression that preservation tends to produce, in 20 patients against 4 of 16 controls.

Rests on: Şirinoğlu, the Pitanguy ligament and the supratip break · Erdal et al., transection in preservation · and the anatomy of the nose.

By cause, and what each one needs

The four mechanisms, and the operation each one points to.

An under-projected or dropped tip

The commonest cause, at 68% of the polly-beaks in the largest series. The supratip is not too high; the tip is too low, and the profile reads convex because of it. The correction is tip support, a caudal septal extension graft or a columellar strut, not shaving the supratip.

Rests on: Hussein et al. · and nasal tip.

Scar filling the supratip dead space

36% of the same series. Blood and then fibrous tissue occupy the pocket left under thick skin after the cartilage beneath it is lowered. This is the one that answers to steroid, injected on a protocol and early; the published treatment papers pair the injection with the operation rather than using it alone.

Rests on: Hussein et al. · and complications and their management.

An over-resected bony dorsum

28%. Taking too much bone drops the bridge above the supratip, so a normal supratip now sits proud of it. The correction is to rebuild the dorsum, not to reduce the supratip further.

Rests on: Hussein et al. · and dorsal hump reduction.

Cartilage left high at the anterior septal angle

24%. The simplest mechanism and the only one where trimming the supratip is the answer: the cartilaginous dorsum was not lowered enough relative to the new tip position.

Rests on: Hussein et al..

Under an implant

In a revision series of 28 ethnic patients, polly-beak and a persistent bulbous tip were the two commonest indications, and most were traced to implant selection and placement. Removing the existing graft was part of the correction in most of them.

Rests on: Slupchynskyj · and ethnic rhinoplasty.

What to ask about a polly-beak

Questions the evidence supports asking, before a second operation.

Which of the four causes is mine?

There is no single polly-beak operation. Ask the surgeon to say which mechanism they think is responsible (dropped tip, scar, over-resected bone, or high septal angle), and what in the examination or the photographs points to it.

Is this scar that may still settle, or structure that will not?

Scar in the supratip changes over the first year and answers to steroid. A dropped tip or a missing dorsum does not change and does not answer to injection. The distinction decides whether the next step is an injection or an operation.

How long should I wait?

The prevention and correction literature works on twelve-month photographs, because supratip swelling in thick skin is still resolving before that. Nothing in these papers supports operating on a supratip at three months.

Rests on: Şirinoğlu · and recovery.

What is being done to stop it coming back?

The named answers are a supratip suture, repair rather than excision of the Pitanguy ligament, control of the dead space, and a steroid protocol where scar is the cause.

Rests on: Hoehne et al. · Şirinoğlu · Hussein et al. · Rohrich et al..

The terms, defined

The words used about this deformity.

  • Polly-beak (pollybeak, parrot beak) deformity: convex fullness of the supratip so the profile runs level or convex into the tip. [27494583]
  • Supratip: the strip of dorsum immediately above the tip. Supratip break, the small dip between dorsum and tip that a straight profile is supposed to have. [40080607]
  • Supratip depression: the opposite fault, a supratip that is too deep; the characteristic over-correction, and a known complication of dorsal preservation. [35908175]
  • Anterior septal angle: the corner of the septum under the supratip; left high, it makes a polly-beak on its own. [27494583]
  • Pitanguy's midline ligament: the band from dorsum to tip through the soft-tissue envelope; repairing it holds the supratip depth, excising it does not. [40080607]
  • Supratip suture: a suture that fixes the skin envelope down into the supratip to close the dead space, in Guyuron's original description and later modifications. [30907809]
  • SFRS (Supratip Fullness Rating Scale): a published grading of supratip fullness, 0 to 3, used to score the deformity before and after correction. [37798507]
  • ROE (Rhinoplasty Outcome Evaluation): the patient-reported questionnaire these series score satisfaction with. [37798507, 35908175]

Where else this is documented

Sources outside the journals, each one free to read.

The national guideline

The American Academy of Otolaryngology publishes a clinical practice guideline on nasal form and function after rhinoplasty, with a plain language summary written for patients. It sets what a surgeon should assess and record before a first operation, which is where this deformity is prevented.

Rests on: the clinical practice guideline · the plain language summary.

What is not settled

  • The reported frequency ranges from 62% of revision patients in the largest series to "up to 50% of cases" quoted from older literature. Nobody has counted it prospectively in a primary series. [27494583, 25076457]
  • Whether the Pitanguy ligament should be repaired, transected or left alone depends on which operation is being done, repair in open structural work, transection in low-strip preservation , and the two findings come from different groups on different patients. [40080607, 35908175]
  • The steroid protocols are described rather than compared: no trial sets dose, interval or start time against an alternative. [27494583]
  • Every prevention technique on file is a single centre's consecutive series with no control arm beyond the surgeon's own earlier patients. [30907809, 36042029]
  • The grading scales are new and single-centre; SFRS has not been used outside the series that proposed it. [37798507]

Written by rhinoplasty.cc from the sources linked above, 2026-09-09.

Who publishes on revision and secondary rhinoplasty

Ranked surgeons with papers under this topic in the archive, most first.

Rod J. Rohrich (8) · Dean M. Toriumi (7) · Samuel Lin (5) · Richard E. Davis (4) · Sam P. Most (4) · Michael Lee (3) · Paul Nassif (2) · Angela Sturm (1) · Anil Shah (1) · Anita Patel (1)

The literature: Revision and secondary rhinoplasty, 181 papers. Video: Revision and secondary, 322 videos. Every technique.