Pollybeak Deformity in Middle Eastern Rhinoplasty: Prevention and Treatment

Abstract

The pollybeak deformity is one of the commonest causes of revision rhinoplasty. The Middle Eastern nose has certain criteria that predispose to the development of pollybeak deformity. The aim of this study is to detect the factors contributing to the development of pollybeak deformity in the Middle Eastern nose and methods used to prevent as well as to treat such deformity. Out of the 1,160 revision patients included in this study, 720 (62%) patients had a pollybeak deformity. The commonest contributing factors included underprojected tip with poor support in 490 (68%) patients, excessive supratip scarring in 259 (36%) patients, overresected bony dorsum in 202 (28%) patients, and high anterior septal angle in 173 (24%) patients. The methods used by the authors to treat the pollybeak deformity are described, along with the local steroid injection protocol used to guard against the recurrence of pollybeak deformity.

Keywords

rhinoplasty - tip support - pollybeak deformity - steroid injection - thick skin - revision surgery

• References

• 1 Guyuron B, DeLuca L, Lash R. Supratip deformity: a closer look. Plast Reconstr Surg 2000; 105 (3) 1140-1151 , discussion 1152–1153
• 2 Daniel RK. Middle Eastern rhinoplasty in the United States: part II. Secondary rhinoplasty. Plast Reconstr Surg 2009; 124 (5) 1640-1648
• 3 Daniel RK. Middle Eastern rhinoplasty in the United States: part I. Primary rhinoplasty. Plast Reconstr Surg 2009; 124 (5) 1630-1639
• 4 Foda HM. External rhinoplasty for the Arabian nose: a columellar scar analysis. Aesthetic Plast Surg 2004; 28 (5) 312-316
• 5 Foda HM. Management of the droopy tip: a comparison of three alar cartilage-modifying techniques. Plast Reconstr Surg 2003; 112 (5) 1408-1417 , discussion 1418–1421
• 6 Foda HM. Rhinoplasty for the multiply revised nose. Am J Otolaryngol 2005; 26 (1) 28-34
• 7 Apaydin F. Rhinoplasty in the Middle Eastern nose. Facial Plast Surg Clin North Am 2014; 22 (3) 349-355
• 8 Rohrich RJ, Ghavami A. Rhinoplasty for Middle Eastern noses. Plast Reconstr Surg 2009; 123 (4) 1343-1354
• 9 Sajjadian A. Rhinoplasty in Middle Eastern patients. Clin Plast Surg 2016; 43 (1) 281-294
• 10 Ha RY, Nojima K, Adams Jr WP, Brown SA. Analysis of facial skin thickness: defining the relative thickness index. Plast Reconstr Surg 2005; 115 (6) 1769-1773
• 11 Constantian MB. Four common anatomic variants that predispose to unfavorable rhinoplasty results: a study based on 150 consecutive secondary rhinoplasties. Plast Reconstr Surg 2000; 105 (1) 316-331 , discussion 332–333
• 12 Rettinger G. Risks and complications of rhinoplasty [in German]. Laryngorhinootologie 2007; 86 (Suppl. 01) S40-S54
• 13 Hussein WK, El-Badan H, Sheweel Y, Bazak R. Alar lift: sail excision technique for alar overhanging in the Middle Eastern Nose. Egyptian J Ear Nose Throat Allied Science 2015; 16 (1) 13-17
• 14 Bizrah MB. Rhinoplasty for Middle Eastern patients. Facial Plast Surg Clin North Am 2002; 10 (4) 381-396
• 15 Peck GC, Michelson LN. Anatomy of aesthetic surgery of the nose. Clin Plast Surg 1987; 14 (4) 737-748
• 16 Gibson T, Davis B. The distortion of autogenous cartilage grafts: its cause and prevention. Br J Plast Surg 1957; 10: 257-274
• 17 Foda HM. Mersiline mesh in premaxillary augmentation. Aesthetic Plast Surg 2005; 29 (3) 169-173
• 18 Foda HM. The caudal septum replacement graft. Arch Facial Plast Surg 2008; 10 (3) 152-157
• 19 Anderson JR. Symposium: the supra-tip in rhinoplasty: a dilemma. III. Supra-tip soft-tissue rounding after rhinoplasty: causes, prevention and treatment. Laryngoscope 1976; 86 (1) 53-57
• 20 Wright WK. Symposium: the supra-tip in rhinoplasty: a dilemma. II. Influence of surrounding structure and prevention. Laryngoscope 1976; 86 (1) 50-52
• 21 Patterson CN. Symposium: the supra-tip in rhinoplasty: a dilemma. I. Theories and causes of supra-tip convexities. Laryngoscope 1976; 86 (1) 45-49
• 22 Farrior RT. Symposium: the supra-tip in rhinoplasty: a dilemma. Laryngoscope 1976; 86 (1) 43-44
• 23 Tardy Jr ME, Kron TK, Younger R, Key M. The cartilaginous pollybeak: etiology, prevention, and treatment. Facial Plast Surg 1989; 6 (2) 113-120
• 24 Nemati S, Banan R, Alizadeh A, Leili EK, Kerdari H. Ultrasonographic evaluation of long-term results of nasal tip defatting in rhinoplasty cases. Laryngoscope 2013; 123 (9) 2131-2135
• 25 Boyadjiev C, Popchristova E, Mazgalova J. Histomorphologic changes in keloids treated with Kenacort. J Trauma 1995; 38 (2) 299-302
• 26 Trisliana Perdanasari A, Lazzeri D, Su W , et al. Recent developments in the use of intralesional injections keloid treatment. Arch Plast Surg 2014; 41 (6) 620-629