Complications of Rhinoplasty - Page 8

Alar—Columellar Disproportions

Figure 39—2 The alar—columellar relationship can be described with nine possible anatomical combinations. (From Toriumi DM, Becker DG. Rhinoplasty Dissection Manual. Philadelphia : Lippincott Williams & Wilkins; 1999. With permission.)

Pollybeak
A pollybeak refers to postoperative fullness of the supratip region, with an abnormal tip—supratip relationship (Fig. 39—3). This may have several causes, including failure to maintain adequate tip support (postoperative loss of tip projection), inadequate cartilaginous hump (anterior septal angle) removal, and/or supratip dead space/scar formation.

Management of the pollybeak deformity depends on the anatomical cause. If the cartilaginous hump was underre­sected, then the surgeon should resect additional dorsal sep­ tum. Adequate tip support must be ensured; maneuvers such as placement of a columellar strut may be of benefit. If the bony hump was overresected, a graft to augment the bony dorsum may be beneficial. If pollybeak is the result of exces­sive scar formation, Kenalog injection or skin taping in the early postoperative period should be undertaken prior to any consideration of surgical revision.

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