Over-Rotated Nasal Tip

An over-rotated nasal tip, also known as a piggy nose, is the most challenging aspect of tip surgery. The over-rotated nasal tip varies in characteristics, severity, and etiology, but some features are common to all manifestations of the deformity. From the front, the over-rotated tip is characterized by increased nostril show. In the profile view, the over-rotated tip has a decreased nasal bridge length (radix to tip) and an increased nasolabial angle. Over- or under-projection of the nasal tip may be observed depending on the patient. The characteristics of the short nose vary and depend on the etiology. However, four main elements are generally present, either in isolation or in combination: a lack of alar cartilage; a weakened or fractured cartilaginous septum; scar tissue; and soft tissue contracture. Skin and scar tissue can affect the outcome of over-rotated tip surgery. Skin resistance represents an important obstacle when rotating the tip forward and downward; this situation must be discussed with the patient preoperatively such that their expectations are realistic. To avoid wound-healing problems, the skin should not be stretched excessively.