How to Reduce the Probability of a Pollybeak Deformity in Primary Rhinoplasty: A Single-Center Experience

Abstract

Summary: Being a very common and highly stigmatizing deformity following primary rhinoplasty, a pollybeak deformity should be avoided during any primary rhinoplasty, especially in patients with thick nasal skin. Two surgical techniques used in the authors’ department to decrease the probability of its development in at-risk patients are described in this article: the authors’ modification of the supratip suture initially described by Guyuron, and a direct excision of excessive skin that the authors term supratip excision, reserved for rare cases with massive skin excess. In addition, a brief overview of the results of the authors’ case series of 74 patients treated with the supratip suture technique, and 21 patients treated with the supratip excision technique over a 5-year period, is given. In the authors’ experience, very good aesthetic results are achieved using either of the two techniques in selected cases.

Surgical and Nonsurgical Management of the Nasal Skin-Soft Tissue Envelope

“…6,24,46,65 As mentioned above, a preservation or reconstruction of the Pitanguy ligament system and vertical scroll ligaments may reduce the dead space and increase tip definition significantly. 14,24,49,63,65 Suturing in the supratip area-a reconstruction of the deep Pitanguy ligament-to remove dead space has been described to enhance the definition of the supratip break point. 24,65 Postoperative taping and splinting can further help to avoid dead space fibrosis formation.…”

“…14,24,49,63,65 Suturing in the supratip area-a reconstruction of the deep Pitanguy ligament-to remove dead space has been described to enhance the definition of the supratip break point. 24,65 Postoperative taping and splinting can further help to avoid dead space fibrosis formation. 23,24,65 Techniques That Include Partial Resection of Complete Skin's Thickness There are several techniques that include resecting excess full thickness skin.…”

“…24,65 Postoperative taping and splinting can further help to avoid dead space fibrosis formation. 23,24,65 Techniques That Include Partial Resection of Complete Skin's Thickness There are several techniques that include resecting excess full thickness skin. 24,[65][66][67] The concept is to restore the balance between SSTE and OCF.…”

“…23,24,65 Techniques That Include Partial Resection of Complete Skin's Thickness There are several techniques that include resecting excess full thickness skin. 24,[65][66][67] The concept is to restore the balance between SSTE and OCF. Several authors described multiple techniques in this regard.…”

“…4). 24,65,66,68 Some authors advocate the skin excision on the root of the nose over the excision in the supratip as the abundance of sebaceous glands in the supratip area may result in a conspicuous scar, whereas while the skin over the root of the nose is thinner and have less sebaceous glands allowing less visibility of the scars. The skin resection is reserved for refractory cases and should only be indicated and conducted by very experienced surgeons, as the scar is very critical.…”