Polly Beak Deformity (Pollybeak): Causes, Types and Treatment

A polly beak deformity — also written pollybeak, and sometimes called supratip fullness — is a rounded prominence just above the tip of the nose that gives the profile a downward-curving, beak-like appearance. It is the commonest aesthetic complication of rhinoplasty.

The name describes what it looks like from the side: the area immediately above the tip sits higher and fuller than the tip itself, so the profile arcs over and down rather than stepping cleanly into a defined tip.

Two things about it are worth knowing before anything else, and most pages on this subject skip both.

First, most apparent polly beak in the first six months is swelling, not deformity. Supratip skin is the thickest on the nose and the slowest to settle. Judging the shape at three months is judging oedema.

Second, when it is genuine, there are two different types with two different causes and two different treatments. Getting that distinction right is the whole of the decision, and injecting steroid into the wrong type achieves nothing while injecting too much causes a fresh problem.

This guide covers what a polly beak is, why it happens, how to tell the two types apart, when to wait and when to act, and what revision rhinoplasty involves if it comes to that.

What a Polly Beak Deformity Looks Like

In a well-proportioned nose there is a subtle dip just above the tip, called the supratip break, and the tip sits slightly higher than the bridge immediately behind it. That relationship is what makes a tip look defined.

In a polly beak the relationship inverts. The supratip becomes fuller and higher than the tip, the break disappears, and the profile curves smoothly over the top and down towards the nostril — the shape of a parrot’s beak, which is where the name comes from.

Supratip nose fullness of this kind is a profile problem almost exclusively. From the front the nose may look entirely normal, which is why people often notice it first in a side-on photograph rather than in the mirror.

Associated features include a tip that looks under-projected or droopy even when it has not moved, loss of definition at the tip, and an apparently longer nose.

The Two Types

Soft tissue polly beak

The cartilage sits at the correct height, but the soft tissue above the tip has thickened. Scar tissue forms in the dead space created when the dorsum was reduced, and where skin is thick it does not contract down onto the new lower framework — it fills the gap instead.

This is the more common type, and it is the one that responds to non-surgical treatment. It feels soft and slightly spongy on gentle pressure. It is more likely in people with thick sebaceous skin, and it typically appears or worsens between three and six months, sometimes later.

Cartilaginous polly beak

The soft tissue is normal but the cartilage of the middle vault — the upper lateral cartilages and the dorsal septum just above the tip — has been left too high relative to the tip. Alternatively the tip has lost projection or dropped, which produces the same relative excess without anything above changing at all.

It feels firm rather than spongy. It is present from early on and does not improve with time or with steroid, because there is nothing soft to reduce. This type requires surgical correction.

Telling them apart

Palpation is the main test — soft and compressible suggests soft tissue, firm and unyielding suggests cartilage. Timing helps: appearing late points to scar, present from the start points to structure. Skin thickness matters, as does what was done at the original operation.

In practice the two frequently coexist, and a nose can have a genuine cartilaginous excess with additional soft tissue thickening over it.

Why Polly Beak Happens

It is worth being direct about this: polly beak is usually a technical misjudgement at the first operation rather than bad luck. The commonest causes are all avoidable, and knowing them is useful if you are choosing a surgeon for a first rhinoplasty.

• Over-reduction of the dorsum relative to the tip. If the bridge is lowered more than the tip is supported, the tip becomes the low point. This is the single commonest cause.
• Inadequate tip support. Where the tip is not adequately stabilised with grafts or sutures, it drops during healing while the supratip stays put. Loss of tip projection creates a polly beak without anything above it changing.
• Leaving the cartilaginous dorsum too high. Reducing the bony hump correctly but under-reducing the cartilage just above the tip.
• Over-resection of the caudal septum, which allows the tip to rotate up and back.
• Failure to plan for thick skin. Thick supratip skin will not shrink onto a reduced framework. It needs either less reduction or more tip projection to take up the slack — and where that is not anticipated, scar fills the space.
• Dead space and haematoma. Bleeding or fluid collecting in the supratip encourages heavier scar formation.

Thick skin is the single biggest predisposing factor. It is not a cause on its own, but it converts a small technical margin into a visible one.

When to Judge It: The Timeline

This is the part most people need and most content omits.

• 6 weeks — the majority of gross swelling has gone, but supratip oedema is still substantial. Far too early to draw conclusions.
• 3 months — supratip fullness commonly becomes noticeable here, and this is when most people first raise it. In many cases it is still swelling.
• 6 months — the shape is becoming reliable. Steroid injection is often considered from around this point for soft tissue fullness.
• 12 months — the true result. Revision surgery is not usually considered before this, and 12 to 18 months is more typical in thick skin.

Operating on a nose that is still resolving risks correcting a problem that would have settled anyway, and revision performed too early carries a higher failure rate because the tissues are still inflamed and scarring is immature.

The exception is soft tissue fullness that is clearly established and not improving between visits — steroid injection can reasonably begin before 12 months, because it is reversible in a way surgery is not.

Treatment

Steroid injection — soft tissue type only

Dilute triamcinolone, commonly known by the brand name Kenalog, injected into the supratip scar reduces its bulk. Typically two to three treatments six weeks or more apart, each taking a couple of minutes with no downtime.

It works well for genuine soft tissue fullness. It is also the treatment most often misused, and there are two real risks worth understanding.

Over-injection causes skin atrophy — thinning, visible surface irregularity, and sometimes a depression where the fullness was. That is harder to correct than the original problem. Telangiectasia, small visible surface vessels, and hypopigmentation can also occur, particularly in darker skin.

For this reason injections should be dilute, spaced, conservative, and performed by someone experienced in nasal injection specifically. Being told to expect a course of six or more should prompt a second opinion.

Steroid does nothing for the cartilaginous type. Injecting it repeatedly into a nose whose problem is structural wastes months and risks the skin for no gain.

Taping and massage

Supratip taping in the first months may modestly reduce swelling and discourage scar accumulation. Evidence is limited but the risk is minimal, and many surgeons recommend it. It is preventive rather than corrective — it will not resolve established fullness.

Revision rhinoplasty

Required for the cartilaginous type, and for soft tissue fullness that has not responded to conservative treatment.

What is done depends on the cause. Where cartilage sits too high, the dorsal septum and upper lateral cartilages are reduced precisely at the supratip. Where the tip has lost projection or dropped — frequently the real problem — the correct answer is increasing tip projection and support rather than removing anything, using a septal extension graft, columellar strut or tip grafts. Excess scar can be excised directly, and dead space closed with supratip sutures to discourage it reforming.

That distinction is important. A polly beak caused by tip drop and corrected by lowering the supratip further produces a smaller nose with the same relative problem. The fault is the relationship between the two, not the height of one.

Revision is performed no earlier than 12 months after the original surgery, usually via an open approach for accurate assessment, and often needs cartilage from the ear or rib where septal cartilage was used or removed the first time. See revision rhinoplasty.

Can Polly Beak Be Prevented?

Largely, yes, and this is the most useful section if you have not yet had surgery.

• Adequate tip support planned from the outset — the tip must end up projecting further than the supratip, with the structure to hold it there.
• Conservative dorsal reduction, particularly in thick skin. Preservation techniques that reposition rather than remove reduce dead space substantially. See preservation rhinoplasty.
• Honest assessment of skin thickness before surgery. If your surgeon has not mentioned your skin thickness and what it means for your result, ask.
• Meticulous haemostasis and supratip taping in the early healing period.

If you are choosing a surgeon for a first rhinoplasty, asking how they plan to avoid supratip fullness given your skin type is a genuinely revealing question.

Cost

Steroid injection is a minor outpatient treatment and priced accordingly. Revision rhinoplasty is more complex than primary surgery and cost depends on what is required — whether grafts are needed, whether cartilage must be taken from ear or rib, and the anaesthetic involved. Your exact cost is confirmed in writing after in-person consultation.

Where your original rhinoplasty was performed at Centre for Surgery, revision arrangements are discussed as part of our aftercare. Where it was performed elsewhere, we assess and quote as a new case — we see a significant number of patients seeking correction of surgery done by other providers, and we will give you an honest assessment of what can be improved and what cannot.

Finance is available through Chrysalis Finance, subject to status — see our finance options.

Polly Beak Deformity FAQs

Assessment at Centre for Surgery

If you are concerned about supratip fullness after rhinoplasty, assessment covers three questions: whether this is swelling or established, whether it is soft tissue or cartilaginous, and whether the real problem is excess above the tip or insufficient projection of the tip itself.

That third question is the one most often answered wrongly, and getting it wrong means operating on the wrong part of the nose.

We see a considerable number of patients seeking correction of surgery performed elsewhere. Where the honest answer is to wait, we will say so — and where the fullness is unlikely to improve meaningfully, we will say that too rather than book an operation.

All surgery is performed by GMC-registered surgeons at our own day-surgery facility at 95–97 Baker Street, Marylebone. We are regulated by the Care Quality Commission and rated Good overall. We recommend a two-week cooling-off period before any surgery is booked.

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Related Reading

• Revision rhinoplasty
• Rhinoplasty (nose job)
• Preservation rhinoplasty
• Rhinoplasty recovery
• Nose shapes: the common types
• Saddle nose deformity
• Nasal valve collapse
• Dorsal hump removal
• Open vs closed rhinoplasty