Rhinoplasty is one of the most commonly performed corrective facial surgeries. According to the American Society of Plastic Surgeons, some 353,555 rhinoplasties were performed in the United States in 2020 (American Society of Plastic Surgeons 2020). Supratip fullness, also known as soft tissue polly beak deformity, remains a common complication of rhinoplasty and a factor in patient dissatisfaction (Parkes et al., 1992; Foda 2003; Gupta and Constantinides 2013; Slupchynskyj and Rahimi 2014) that often requires revision surgery (Foda 2005; Kim et al., 2012; Rohrich et al., 2020). It is described as an iatrogenic convexity/fullness on the dorsal line located immediately cephalad to the nasal tip. The tip has a rounded appearance with no supratip break and resembles a parrot's beak. A supratip break is anatomically caused by the difference in projection between the domes of the alar cartilages and the dome of the dorsal septum and upper lateral cartilages.

Supratip prominence can occur as a natural feature without previous surgery.

Guyuron et al. (2000) reported that 9% of primary rhinoplasty candidates demonstrate supratip deformity. In contrast, Foda et al. (2003) reported that 39% of primary rhinoplasty cases presented with polly beak. After secondary rhinoplasty, the incidence ranges from 33% to 64% (Swanepoel and Eisenberg 1981; Parkes et al., 1992; Guyuron et al., 2000; Vuyk et al., 2000; Foda 2003). The percentage is 62% for the Middle Eastern nose, of which 36% of all cases of polly beak is due to excessive scarring in the supratip region (Hussein and Foda 2016).

Notably, a majority (50%–64%) of secondary rhinoplasties are undertaken to correct polly beak (Foda 2005; Rettinger 2007; Kim et al., 2012).

There are several possible causes underlying this deformity. Either cartilage or soft tissue factors can be at the root of this unaesthetic complication. Polly beak is usually caused by overprojection of the cartilaginous dorsum, over-resection of the bony dorsum, under-projection of the tip, or a combination of these factors. Excessive supratip soft tissue or cephalic orientation of the lateral crura can also contribute (Guyuron et al., 2000; Gupta and Constantinides 2013). This is demonstrated in Fig. 1. Cartilaginous polly beak deformity is often technique related and can therefore be avoided.

Thick-skinned people are more prone to developing soft tissue polly beak deformity given the poor re-draping and contraction capacity of thick and sebaceous skin (Whitaker and Johnson 2002; Hussein and Foda 2016; Hoehne et al., 2019; Aydın et al., 2021). If the osseocartilaginous framework is significantly reduced, thick skin cannot fully re-drape over the lowered dorsum, resulting in dead space with infiltration of granulation and fibrotic tissue (Fig. 1). Most authors agree that this the main cause of soft tissue supratip deformity (Sheen 1997; Guyuron et al., 2000; Cochran and Landecker, 2008; Hussein and Foda 2016; Hoehne et al., 2019), underscoring the need for adequate support for the heavy skin/soft tissue envelope.

The more challenging cases to manage are polly beak due to soft tissue infiltration despite adequate cartilage support. Several surgical and postoperative techniques have been described to prevent or overcome soft tissue polly beak deformity in primary and secondary rhinoplasty, but no consensus has been reached, and strong evidence is lacking. A scoping review was conducted in order to systematically map the research done in this area, to summarize the findings, and to identify any existing gaps in knowledge. The following research question was formulated: “Which surgical preventive measures and postoperative methods for addressing soft tissue polly beak deformity exist, and what are their postoperative results?"