In a natural-looking nose, there is a slight depression as the nose transitions from the bridge to the tip. In the case of the polly beak deformity, however, this bridge area above the tip is too high, giving the nose an appearance like a parrot’s beak. Three different complications during rhinoplasty can lead to this problem, which is one of the most common seen after rhinoplasty surgery.
The “Middle Vault,” also known as the “Inverted V Deformity,” occurs when a bump is removed from the central nose, but inadequate support is provided. The center of the nose collapses, both inhibiting breathing and making the nasal bones visible to the naked eye in the shape of an inverted “V.” Breathing will also be inhibited when the removal of a bump causes the collapse of the narrowest area inside the nose, the internal nasal valve. As with a scooped out bridge, a revision rhinoplasty to address a collapsed central nose or internal valve collapse involves rebuilding the missing area with the patient’s own cartilage.
A deviated nose is a nose with twist-either in the upper, middle, or tip of the nose. It is one of the most difficult problems to address through rhinoplasty and can persist after a original rhinoplasty or a revision rhinoplasty. It can even be introduced through a rhinoplasty or revision rhinoplasty procedure. A frequent cause of a pre-existing deviation is crooked nasal bones. When the problem is introduced through surgery, it is sometimes because the efforts to remove a bump or other issue cause bones to shift. The techniques to address deviations vary widely depending on where the twist occurs and all the details are highly technical. If your problem involves a deviation in the nose, please discuss it with Dr. Rawnsley one-on-one, for an expert analysis of your particular situation and the best approach to address it.
One of the most common mistakes seen following rhinoplasty is the over-protected tip. Once a prominent bump is removed, patients often discover that the tip of the nose projects too far from the face. The problem can be exacerbated if the bridge of the nose slopes too much post-surgery. In many cases, surgeons simply do not dare tackle the issue of the over-protected tip during a rhinoplasty because the techniques to deproject the tip are highly technical and require advanced skill and a deep well of experience. The surgeon would rather avoid the procedure entirely than risk reducing the tip too much. In addition, it is practically impossible to meaningfully reduce the tip in a standard “closed” rhinoplasty procedure. Only an “open” procedure, such as those performed by Dr. Rawnsley (where the flesh between the nostrils is cut), can effectively achieve true deprojection of the tip. The good news is that once a proper open procedure has been performed the structural support for the tip of the nose is far stronger than it would have been without revision rhinoplasty.
It is important to remember that whenever a rhinoplasty is performed, it involves two separate procedures, one to the right side of the nose and one to the left. In every stage of the surgery, great attention must be paid to symmetry. The cartilage on both sides of the nose tip must be removed to exactly the same degree or and asymmetric tip will result. Asymmetries may also occur due to unequal scarring during the healing process and not reveal themselves until months or even years after the fact. For a successful revision rhinoplasty, the surgeon must pay careful attention to symmetry at every stage of the procedure and through extensive experience anticipate how the scar tissue is likely to form and adjust accordingly for a final, aesthetically satisfying result.
A “unitip deformity” is the term given to the problem where the two points of cartilage (like two wings) that form the nose tip are pulled so close together it appears as if the nose comes to a single point. The problem usually occurs when a surgeon cinches down the suture between the tip points too tightly. To correct the problem, the points must be separated and rebuilt with cartilage to achieve the proper balance.
Radix height relates to the angle formed between the frontal and nasal bones of the nose. This height must be in proper proportion to the length, tip projection, and dorsal height to bring about a perfectly balanced, elegant result. If the radix is left too high or if too large a radix graft is put in place during surgery, the nose will have an inelegant, Romanesque quality afterward. The revision rhinoplasty procedure to correct the problem involves the reduction of the radix to its proper, most aesthetically pleasing proportions, given the other aspects of the nose and overall facial shape.
