Nose dips and spreads when smiling?

You should see a rhinoplasty expert for a consultation. In select cases, though, Botox injections into the depressor septi muscle (where the nose meets the upper lip midline) can help minimize the droopy nasal tip upon smiling but it won't help with the flaring of the nose. There is really no other non-surgical alternative, certainly not to the other issues you described. It also sounds that you have weak nasal tip support, which should be corrected. A rhinoplasty will likely be the best option, both for aesthetic and functional (nasal breathing) purposes, but as mentioned above, only a rhinoplasty expert with an in-office evaluation can make an appropriate recommendation for your specific case. Best wishes!

To prevent the nose from dipping when smiling requires releasing of the depressor septi ligament. This ligament pulls the tip down when smiling and animating. Releasing of the depressor septa ligament is usually done in conjunction with the rhinoplasty procedure.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  This is a very common issue which can be fixed with rhinoplasty.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon