Options to Fix Nasal Flare when Smiling?

Question

I have this excessive nasal flare when smiling. In repose the nose (widths) looks ok. The width of my nose increases a lot when I am smiling and laughing.I feel very embarrassed when I look at my photos. Is there an option of cutting the muscle which is pulling the base when smiling? Or could that problem be treated with Botox? Please, any advice would be appreciated. Thanks so much.

Farbod Esmailian, MD · Answer

If your nose is normal in repose then there is no issue.  It may be that your smile does cause an over excessive flare but for you this is normal, as it is for many others.
As I agree with others botox can help with this but not significantly.

Otto Joseph Placik, MD · Answer

Botox can be injected but seek the care of an experienced injector. In some cases this may cause a lowering of the upper lip. If you find this undesireable, then the good news is that the result is temporary.
On rare occasion, I have performed modified alar weir excisions with a permanent alar cinching suture to hold the nostrils in place when animating. I have performed the alar cinching suture alone but have not been impressed with the results.

Tanveer Janjua, MD · Answer

Nasal flaring can increase the apparent width of the base of the nose especially during smiling. It can be significantly improved by removing small wedge like areas in the junction of the nose and the cheek caller Weir or Alar resections.
http://janjuafacialsurgery.com/photos/prhinoplasty3.htm
Regards

Toby Mayer, MD · Answer

NO SURGERY!  The best option is botox which is reversible if you don't like it. Surgery can result in a permanent unnatural smile which can't be corrected.

William Portuese, MD · Answer

The rhinoplasty is a static operation done for a static nose. On repose the nose will still widen, although usually it lifts after the surgery. Botox would be an alternative to try in this area. You do not want to have the smile muscle cut, it could look like paralysis from a stroke and would be permanent. Make sure that you do not need a Weir’s alarplasty in attempt to address the alar flare on repose.

Steven Wallach, MD · Answer

Smiling always causes the nose to look a bit wide.  Botox can block this a bit but may affect your smile. If you really have flare, then alar flare reduction can be performed surgically.

Richard W. Fleming, MD (retired) · Answer

Nasal flare with smiling is normal. If excessive, this is not improved with surgery, but Botox can be used. Because Botox is temporary, you will have the opportunity to evaluate your appearance before continuing will subsequent injections.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,
The nostrils have horizontal and vertical width dimensions. Nasal width or flaring can be treated by narrowing the nostrils in a horizontal dimension. This reduces the horizontal width between the collumella and alar base of the nostril.
I don't think getting Botox is a good idea because of potential complications, such as a droopy lip.
Best,
Dr. S.

David B. Reath, MD (retired) · Answer

There a number of factors that can contribute to flaring of your nose when smiling or animating your face.  However, if you nose looks OK in repose (when not smiling), this is most likely do to the action of a very small muscle at the bottom of your nose. This muscle, the depressor septi nasi muscle, pulls the base of the nose back and to the sides when you smile.
As this is a small muscle this may be a little hard to hit with Botox.  However, if other muscles of your face are contributing to this, the Botox may help.  But, as always, this has to be done carefully so that muscles that you need will not be weakened too much.  You need to be seeing an experienced injector for this.
This muscle can be divided surgically.  Frequently I will do this with a rhinoplasty.  It is fairly simple to do, but you will have some numbness of your upper lip for a couple of months.
Good luck!
David B.

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