A New Technique for Correction of Fibrous Pollybeak Deformity Using a Rotational V-Shaped Flap in Secondary Rhinoplasty

Abstract

Pollybeak deformity is a postoperative nasal deformity. This occurs when the lower third of the dorsum is more projected than the tip. Several etiologies due to primary and secondary rhinoplasty have been described in the literature. Some of these are preventable, while others are postoperative. We designed a convenient technique to correct fibrous pollybeak deformities presented in revision surgeries. The procedure is performed under tumescent local anesthesia. An open technique was used to expose the supratip deformity. A flap is designed and elevated anatomically from the supratip area and then divided into 2 halves, resulting in a forked flap joined at the vertex resembling a “V.” Then both flaps are overlapped to project the tip to the desired position. The V-shaped flap is fixed in its position by simple sutures to the underlying cartilage. A significant improvement in correcting fibrous supratip deformity was noted in postoperative evaluation. All our patients were satisfied with the result and healed uneventfully with no significant complications. This alternative technique is simple and practical for correction of fibrous pollybeak deformity over traditional techniques. The V-shaped flap can be addressed with 1 maneuver, both the pollybeak deformity and the nasal tip projection.