Nasal Rotation

Abstract

Nasal rotation is another key category into which many revisional deformities reside. The classic “piggy” nose is actuality an extreme upwardly rotated nose, associated with tip deformities. The other end of the rotational spectrum is the droopy downward-tilting deformity.

Rotational deformities are rarely isolated, and are usually associated with other classic problems that can be defined as an aesthetic pathologic syndrome. These syndromes or, more accurately, collections of deformities, do not haphaz- ardly occur. They are a direct result of a preexistent genetic propensity, associat- ed with over- or underresection of several key areas of tissue. Syndrome 1 (see Figure 12-1) which might be labeled the “piggy nose” is a severely upwardly rotated nose and a low bony dorsum. The full-blown syndrome would include a pointy unnatural tip deformity. In this case too much dorsal hump was removed; there is over-resection of the caudal end of the Upper Lateral Cartilages; under- resection of the cartilaginous dorsum and caudal end of the septum; and over- resection of the cephalic borders of the tip cartilages. This full-blown syndrome may exist in part or in totality in any given patient.