Pollybeak and Inverted-V Deformities: Two Common Revision Problems and How They Are Prevented
When patients come to me for revision rhinoplasty, they often bring a folder of photographs and point to something specific that bothers them. Two of the most common concerns have names in the surgical literature: the pollybeak deformity and the inverted-V deformity. Understanding what each one is, and why it happens, helps patients make sense of their own nose and the options for correcting it.
Pollybeak: fullness above the tip
A pollybeak is fullness in the area just above the nasal tip, called the supratip. In profile, the bridge rounds out above the tip instead of sloping cleanly into it, which can resemble the curved beak of a parrot. It is one of the most recognizable signs of a rhinoplasty that has not healed as planned.
There are three main causes, and identifying which one applies is essential because each is treated differently:
Scar tissue in the supratip. After surgery, a space can form between the new framework and the overlying skin. In thicker skin especially, this space can fill with scar tissue. In one multicentre review of 100 pollybeak cases, excess supratip scarring was the most common cause, and the authors noted that it depends largely on the patient's own healing rather than surgical error.
Loss of tip support. If the tip loses projection and settles lower than the bridge, the bridge appears too full above it.
Imbalanced reduction. If the bony upper bridge is taken down too far relative to the cartilage below it, the lower portion of the bridge can appear to stick out.
Early fullness is not always a pollybeak
In the first months after rhinoplasty, the supratip is often the last area to lose its swelling, particularly in thicker skin. Fullness at six weeks is not a diagnosis. When I see the early signs of excess swelling or scar formation in this area, I often use small, carefully placed steroid injections into the deep tissue, combined with taping, to help the skin settle against the new framework. I have written separately about both of these post-operative tools.
Correcting an established pollybeak
When a pollybeak is still present after the nose has fully healed, typically at around a year, the correction is surgical and targets the cause. That may involve lowering the cartilaginous part of the bridge, removing excess scar tissue, or, very often, rebuilding tip support with cartilage grafts so the tip sits at the right height relative to the bridge.
Inverted-V: a shadow on the bridge
The inverted-V deformity is a visible V-shaped line or shadow on the bridge, roughly where the bony upper third of the nose meets the cartilage below it. It tends to appear after a dorsal hump has been removed. When a hump is taken down, the roof of the middle of the nose is opened, and the upper lateral cartilages that form the side walls of the middle third can lose their connection and fall inward. The edges of the nasal bones then show through the skin as an upside-down V.
This deformity is more visible in thin skin, and it may not appear until months or even years after surgery as swelling resolves and the skin thins with age. It also matters functionally. The same collapse that creates the shadow can narrow the internal nasal valve, contributing to the kind of breathing problems I discuss in my article on nasal valve collapse.
Prevention is better than correction
Most inverted-V deformities are preventable. Whenever I remove a hump, the middle third of the nose needs to be addressed. This is done by making sure the nasal bones and the upper lateral cartilages are in alignment, and if they aren't, using spreader grafts, thin strips of cartilage placed alongside the septum, or spreader flaps, which fold the patient's own upper lateral cartilages inward to perform the same job. In appropriate patients, preservation techniques avoid opening the roof of the nose in the first place.
Key takeaway
Pollybeak and inverted-V deformities are among the most common reasons for revision rhinoplasty, but they are well understood. A pollybeak can come from scar tissue, lost tip support, or imbalanced reduction, and each requires a different fix. An inverted-V is a structural collapse that is largely preventable by rebuilding the middle of the nose during the original operation.
Frequently Asked Questions
Can a pollybeak go away on its own?
Early supratip fullness from swelling often improves over the first year, sometimes with help from steroid injections and taping. A pollybeak caused by structural imbalance or lost tip support usually requires surgical correction.
Is an inverted-V deformity a breathing problem?
It can be. The collapse that causes the visible V can also narrow the internal nasal valve, which may make breathing through the nose more difficult.
How long should I wait before revision rhinoplasty?
In most cases about a year after the previous surgery, so that swelling has resolved and the final shape can be accurately assessed.