Question for Dr. Kridel: Can you fix Polly beak deformity due to previous Rhinoplasty surgery?

October 28th, 2011 Dr. Russell Kridel

ANSWER:

A Polly beak deformity is the appearance of a rounded fullness of the lower third of the nose that obscures any definition of the nasal tip.  This nasal deformity can have many causes — including, from a previous primary rhinoplasty surgery or a revision rhinoplasty surgery — and therefore there are many different solutions based on the reasons that the Polly beak has formed. (1) If the tip of the nose has lost projection and now has fallen back closer to the face, it will appear as a Polly beak. The solution here is to re-project the nasal tip by giving it more support, usually through the use of a columellar strut and a tip graft. (2) If the roundness is due to there just being too much cartilage left on the lower bridge of the nose near the tip, simple excision can be done. (3) If, however, too much structure (cartilage) under the skin has been removed and the skin is thick, more structure will have to be added back to the nose to put the overlying skin on stretch so it has more definition; cartilage grafts to the bridge and tip may be necessary. (4) Sometimes the lower third of the nose looks relatively too full when too much has been removed from the upper portion of the bridge and then more cartilage needs to be added back. (5) A small soft tissue Polly beak caused by the formation of scar tissue can sometimes be helped with serial steroid injections to shrink the thick skin.

Revision rhinoplasty is a challenging surgery.  Before having revision rhinoplasty, choose your surgeon carefully.  Make sure the surgeon is a specialist in rhinoplasty and revision rhinoplasty, such as ABFPRS board-certified facial plastic surgeons.  It is also important to find out how many similar procedures the surgeon has performed in the past two to three years.

—-  Dr. Kridel, Houston, TX

Question for Dr. Kridel: I want to have a Revision Rhinoplasty using rib cartilage. What are the risks?

October 25th, 2011 admin

Answer: When large quantities of cartilage are needed in Revision Rhinoplasty, rib cartilage can be the best solution. But, to avoid the scarring, pain, and possible lung puncture of harvesting your own cartilage, rib cartilage can be obtained from a tissue bank safely with no higher a complication rate than using your own cartilage and with the advantage of decreasing your operative and anesthesia time. Please look up this paper to see our experience with over 1000 such grafts with long term follow-up: Kridel RWH et al.: Long-term Use and Follow-up of Irradiated Homologous Costal Cartilage Grafts in the Nose in Arch Facial Plast Surg. 2009;11(6):378-394.  Simply click on the link below to read the complete medical journal article.

—- Dr. Kridel

http://archfaci.ama-assn.org/content/11/6/378.full.pdf+html