THE DROOPING TIP The role of the Pitanguy’s ligament in the position of the nasal tip

The nasal tip is the “mobile” portion of the nose, unlike the nasal pyramid, which is the fixed component. The tip’s anatomical characteristics are determined by intrinsic factors, such as the volume, shape, definition and morphology of the alar cartilages, which, together with the subcutaneous tissue, can profoundly influence the configuration and dynamics of this nasal region. The position of the tip is therefore the result of a complex interaction between size, morphology, position and dynamism of various anatomical components of the lower third of the nose. Two fundamental aspects must be considered in modelling the tip: the projection and rotation, which can be modified by acting on the nose’s cartilaginous structures and on the superficial fibromuscular nasal structure (SMAS). The superficial muscoloaponeurotic system (SMAS) is a dynamic and complex fibromuscular layer able to support and mobilise the osteocartilaginous structure of the nasal pyramid and, moreover, influence the functionality of the nasal valve. This chapter analyses the changes of rotation and projection of the tip, assessing the role taken by the deep medial ligament of the muscoloaponeurotic system (SMA-DML) of the nose, which corresponds, according to many, with the so-called Pitanguy’s ligament in determining the position.