Procedure for Nose That Widens with Smile?

When I smile, my nose ''spreads'' across my face. Is there a procedure to stop me from getting this with a rhinoplasty? Will alar base procedure stop this? Also, I read about doctors being able to ''thin the skin'' on rhinoplasty patients with thick skin how is this performed, and is this the same as nasal smas? Thank you.

Doctor Answers 11

Rhinoplasty questions

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In the course of performing an alar base procedure, many surgeons incorporate an alar cinching suture that restricts lateral movement of the nostril with smiling. Patients may even complain that they are aware of this tightness when smiling after surgery. The long term benefits of this suture are questionable.

Botulinum Toxin preparations in the nasal muscles may help but is of temporary benefit. It may drop your upper lip slightly as well.

Thinning of the skin must be done judiciously because it can compromise the blood supply and cause problems with healing. Steroids will also thin the skin but are discuouraged.

Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Nasal widening with smiling

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Nasal widening with smiling is very common. Typically, this is the result of activity of the nasal alar or dilator alar muscles. It can be more profound in people with widened alar bases or nostrils to begin with. Certainly, narrowing the alar base can reduce the width of the nostrils and may also make it more static when smiling if the resultant narrowing disrupts the muscles that cause the widening to begin with. To thin the skin of the nose can be done but should be approached with trepidation since overly agressive skin thinning or debulking of the dermal fat can result in skin necrosis and loss vis a vis the "Michael Jackson" effect. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Nose that widens when smiling

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Because the alar base of your nose is not directly attached to bone, when you smile, your cheeks pull back and drag the nose with them widening your nose. This is really hard to fix and probably not advisable to try. Just understand that it is normal and happens to everybody to some degree.

Techniques that prevent widening the nose

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Hi and thanks for your question. All procedures that narrow the nostrils will reduce widening upon animation but none will completely eliminate this as no operation affects the facial muscles which are responsible for widening or flaring of the nostrils. See a board certified plastic surgeon experienced in rhinoplasty who can address your concerns in a consultation. Best of luck!

Normal facial animation...

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It’s normal for the nose to widen when patients smile. This occurs because several of the muscles of facial animation insert into the nostril rim.These muscles contract whenever patients smile and this results in spread of the nose.
Although alar cinch procedures can narrow the nasal base width, smiling will still cause spread of the nose. For this reason, nasal spread is something that should probably be accepted as part of normal facial animation.
The nasal skin can be thinned during rhinoplasty surgery, but most surgeons feel that this is a relatively risky maneuver. Thinning the nasal skin can result in skin necrosis, scarring and poor aesthetic results. For this reason, it’s generally not recommended to thin the skin at the time of rhinoplasty surgery.

Options for nose that widens upon smiling

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It is impossible to prevent the nose from widening when smiling. Botox might help with this, but it would end up paralyzing the smile muscle, which is an undesirable result. The rhinoplasty operation is a static operation on the nose, which does not move. Narrowing the nose can certainly be done, but the nose will still widen when smiling even from the more narrow starting point after a rhinoplasty.  For many examples of wide noses we have repaired in our practice, please see the link below to our rhinoplasty photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Increased Nasal Width When Smiling

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If you are unhappy with the width of the nasal base at rest (without facial animation) the base can be narrowed or thinned depending on your particular needs. I will not describe all the alternative techniques; there are many choices. If the nose "spreads" only when smiling, there is little that can be done surgically. I do suggest a good consultation.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Your nose that widens when you smile can be helped.

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All noses widen with a smile. But if your nose widens too far it can be helped. An operation to narrow the side walls (Wier excision) or to significantly narrow the whole lower nostril area (alar base narrowing) may make your problem less noticeable. Also, the more prominent the tip, the less wide the nose will appear (tip rhinoplasty), Selective use of Botox, although short-lived, may be the 'icing on the cake'.

G. Gregory Gallico III, MD
Boston Plastic Surgeon

Nose widens with smile

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Everyone's nose widens when smiling. THis can't really be treated. If you are unhappy with the width in repose( when not smiling) then this can be treated. As for the skin, it is really not advisable to try to thin it out. It may leave depressions in the skin when it heals.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Rhinoplasty and Facial Balance

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It is difficult if not impossible to keep the base of the nose from moving when you smile, and so I wouldn't set this as one of your goals for surgery. However, there is a natural balance between the width of the nose and the width of the mouth when your face is resting (no movement). Some folks have noses that are wider that this ideal, and so it throws off the balance of their central face. Reducing the width of the alar base can narrow the base of the nose and improve this balance, but this is really only seen at rest, not with motion.

In terms of surgically thinning the skin of the nose, I personally think this is difficult to do and even risky to do at the time of surgery. What I will do in some patients in do an injection of Kenalog (a steroid) into the skin several weeks after the procedure-- this steroid will reduce the inflammation and soften the skin a bit, and is a safer approach in my opinion.

Hope that helps,

Dr. Salemy

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.