Will my Nose Job Permanently Affect my Smile?

Question

I just had rhinoplasty a week ago and today my surgeon removed the bandage, splint and stitches. I just tried smiling and realized that I can't smile. My upper lip stretches out and it looks really strange. I'm really, really worried. Will I be able to smile normally again? Will my smile look the same?

Michael A. Persky, MD · Answer

Hi MT,
It sounds like the muscles of your upper lip were freed up from the connections to the tip of your nose.  This is the most common reason for the upper lip to hang down a little more than usual over your upper teeth, and also affect your smile following rhinoplasty.  
We often times perform this maneuver during a Rhinoplasty when elevating the tip.  By detaching the muscles, the tip of the nose is not pulled downward during the initial recovery period.
Fortunately, the effect on your smile should be temporary as the muscles reattach, and the normal function returns.  In my patients it usually takes two to three weeks for the smile to return to normal.  You should speak with your surgeon to find out exactly why your smile is different, and when you can expect it to return to normal.
Enjoy your new nose, and hopefully your old smile very soon. Be well.
Dr. P

Eric M. Joseph, MD · Answer

When we use a columellar strut to enhance tip support, and help maintain tip position, the bottom of the strut is implanted down to the bone above your upper central teeth. The upper lip muscle may be spread to make a pocket, and temporary upper lip heaviness with smiling may occur. This is typically self-limited. Hope this helps.Dr Joseph

Sirius K. Yoo, MD · Answer

It is not unusual for someone's smile to be temporarily affected after rhionplasty because of swelling in the central portion of the lip.  This is especially true if attachments of muscles to the septum and tip were disrupted.  This will typically improve over the course of the first few weeks as the majority of the swelling abates.

Sam Rizk, MD · Answer

Considering that you are only one week into your
recovery, it is extremely early to judge the results of your rhinoplasty. Your
new nose can take up to a year to completely heal, during which time swelling
will likely affect your surrounding facial features. It is understandable that
you are worried about your smile, but you should rest assured that your smile
will not be changed as a result of your nose job. Once the majority of your
swelling has gone down in the coming months, you will be able to resume smiling
naturally.

Richard J. Bruneteau, MD · Answer

Loss of animation of the upper lip following rhinoplasty
surgery is usually always secondary to swelling. In some cases, detachment of
the lip muscles from the distal nasal septum may also contribute to this
problem.

In
the majority of cases, function returns within a week following surgery. In
cases where the muscle attachments are divided, it may take as long as four to
six weeks.

It’s
important to be patient and maintain good communication with your surgeon. Your
surgeon should be able to reassure you and ultimately make this a good
experience.

Rod J. Rohrich, MD · Answer

After rhinoplasty, especially if there is septal work done, there can be some numbness and swelling in the upper central lip area which usually subsides in 6-8 weeks. This can temporarily effect the smile. It is not permanent even when one releases the depressor septi muscles for a short upper lip.

Manish H. Shah, MD, FACS · Answer

Hello,

	As you are very early into your rhinoplasty, there will be a large about of swelling still present in the tip and nasal base for several weeks to come.  Just like a sprained ankle doesn't move well when it is swollen, neither does a nose.  As the swelling comes down the motion should normalize.  I agree with Dr. Persky that release of muscles at the base of the nose/upper lip region can affect your smile.  As long as the muscles were not resected and only freed up, they should scar back down into a similar position.  This should then result in fairly normal lip movement.

	Be patient and good luck,

	Dr. Shah

David Shafer, MD, FACS · Answer

You just had surgery and likely have swelling. It really is too soon for you to get worried. Talk to you surgeon and express your concerns. However, you will likely see improvement over the next several days to weeks. Hang in there...

Pablo Prichard, MD · Answer

In general, almost all noses are numb right after a rhinoplasty. In most cases its the tip that is numb, but this numbness can extend down to the upper lip, and in rare cases some of the teeth. There are nerves that are cut and stretched during a rhinoplasty, and it takes a long time for those nerves to start working again. This is true of an open as well as closed rhinoplasty, although it tends to be more extensive in open rhinoplasty. This could also be more extensive if a septoplasty is performed at the same time. A revision rhinoplasty is a much harder surgery with a lot of internal scarring to cut through.  This can also be a reason for prolonged numbness.  This, along with the swelling, gives you a stiff, plastic type feel, and can give you an odd smile. However, the nerves will start working and again, and your nose stiffness will go away with time. As the nerves grow back, you may feel some tingling, itchiness and on occasion pain. This takes in most cases months, but can take years in rare cases. Extremely rarely, the numbness is permanent, although I have never seen such as case.Best Wishes,Pablo Prichard, MD

William Portuese, MD · Answer

The smile will be very minimally affected for the first few weeks after the surgery because of the stiffness of the upper lip due to swelling from the rhinoplasty. This will subside within the first couple of weeks after the surgery and will not be a permanent problem. Full healing after the rhinoplasty procedure is one year,  so be patient with a healing process.  The amount of swelling present is determined by how much surgery was performed and what techniques were used in addition to the thickness of the skin. For many examples, please see  the link below to our rhinoplasty photo  gallery.

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