17 Polly Beak Deformity
“Polly” is derived from the name “Molly.” In the Cockney rhyming slang once spoken by sailors and pirates, “pretty Polly” meant money. Using the term “Polly” for “parrot” alludes to the profit that was to be made from selling parrots brought back from distant shores. Today it is still common for parrots to be named “Polly,” and “Polly want a cracker” is often the first phrase that parrots are taught to speak. 1
A polly beak ( Fig. 17.1 ) is present when the supratip area projects higher than the tip defining point. This condition is marked by a convex transition from the cartilaginous nasal dorsum to the nasal tip, which resembles a parrot′s beak in profile view. Risk factors for a postoperative polly beak are a deep nasal root, a high cartilaginous dorsum, and a low nasal tip. 2 A polly beak deformity may arise by various mechanisms, which call for different corrective measures. It is important, therefore, to determine the specific cause of a polly beak deformity in each patient before proceeding with revision surgery. Fig. 17.2 shows the pathogenic mechanisms of polly beak deformity and possible ways of preventing them.
17.1 Soft-Tissue Polly Beak
Overvigorous dissection or leaving rough edges or cartilage fragments at the surgical site may evoke an intense connective-tissue reaction and scarring in the supratip area. This is particularly common in thick-skinned patients. 3 Since postoperative swelling can mimic a soft-tissue polly beak, unnecessary revisions can be avoided by always waiting until the swelling has completely subsided. 4
Case 2
Introduction
A 34-year-old woman had undergone two septorhinoplasties elsewhere 4 and 6 years previously. An active jogger, she still had difficulty breathing through the nose and also wanted a better aesthetic outcome. The result after two operations failed to meet her expectations. Moreover, her occupation as a bartender in a Berlin hotel placed her constantly in the public eye, and this increased her desire to have an attractive nose.
Findings
Frontal view ( Fig. 17.3a ) shows a crooked nose with a slight inverted-V deformity on the left side, subluxation of the septum on the right side, and a long infratip triangle. Profile view ( Fig. 17.3b ) shows thick skin, an overprojected tip, absence of a double break, poor tip definition, and a polly beak deformity. Basal view ( Fig. 17.3c ) shows septal subluxation with nostril asymmetry. Fig. 17.3d , Fig. 17.3e , and Fig. 17.3f show her appearance 2 years after revision surgery.
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