Aesthetic SurgeryNasal Tip Rotation by Exclusive Superficial Musculoaponeurotic System Deep Medial Ligament Management An Objective EvaluationGiacomini, Pier Giorgio MDa; Boccieri, Armando MDb; Moretti, Antonio MDc; Rosati, Valentina MDa; Flora, Barbara MDa; Di Girolamo, Stefano MDaAuthor Information From the aOtolaryngology, Clinical and Sciences Translational Medicine Department, University of Rome “Tor Vergata” bPrivate Practice, Villa della Mercede Hospital, Rome cOtolaryngology, Department of Oral Medical and Biotechnological Sciences, “G. D'annunzio” University, Chieti, Pescara, Italy. Received July 17, 2019, and accepted for publication, after revision January 13, 2020. Conflicts of interest and sources of funding: none declared. Reprints: Pier Giorgio Giacomini, MD, Viale Giulio Cesare 14, 00192 Rome, Italy. E-mail: firstname.lastname@example.org. Annals of Plastic Surgery: July 2020 - Volume 85 - Issue 1 - p 12-17 doi: 10.1097/SAP.0000000000002319 Buy Metrics Abstract The nasal tip constitutes the mobile portion of the nose, in direct contraposition to the pyramid that is a fixed structure. Its configuration, position, and shape are derived mainly from the outline and from the thickness of the wing cartilages, important elements of the nasal tip, that together with skin and subcutaneous tissue can deeply influence the configuration and dynamics of this section of the nose as well. In reshaping the nasal tip, 2 fundamental concepts must be considered: projection and rotation; these may be modified, acting on the nasal cartilaginous framework and/or on the superficial nasal fibromuscular structure (SMAS). The aims of this study are to evaluate the nasal tip changes in terms of rotation and projection obtained just acting on superficial muscle aponeurotic deep medial layer without performing any dissection or modification of the nasal tip framework, and to try to explain these possible changes according to the SMAS structure rearrangements only. Twenty-one patients (18 female and 3 male) were subjected to closed rhinoplasty, without tip cartilage dissection/modification. Preoperative and postoperative tip rotation angle, nasolabial angle, and tip projection were measured. The only tip procedure performed was the resection of the SMAS deep medial layer. Our results show significant rotation of the nasal tip and no statistically significant tip deprojection. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.