Botox for depressor septi nasi muscle?

Question

My nose droops down when I smile, which I don't like. However, I am concerned how this will affect my smile, in addition to my flute playing and whistling. Besides keeping my nose from bending down when I smile, how else will my smile change? Will it lengthen my upper lip? Will it make my smile less gummy or more gummy? etc. Also, will I still be able to whistle or play flute just as well as before, or will paralyzing this muscle affect these abilities? Thanks in advance!

William Numa, MD, FACS · Answer

It is very common for an overactive depressor septi muscle to cause a drooping nasal tip. Treatment with a small dose (almost never more than five units) of Botox can take care of this concern. When injected properly and using the right dilution, it is very unlikely for it to cause untoward side effects.

Jason Emer, MD · Answer

Neurotoxins work great to help this specific bother, however given the history you are stating above I would be very cautious about anything that can interfere with function of the lips.  Direct injection into the depressor septi with low concentration of toxin should have no effect on the lip elevators or the oribcularis which is used for pursing of the lips -- both necessary for flute plying.  However, it is still a risk if the toxin spreads distant from the site of injection.  I would suggest using Botox over Dysport for this specific reason.  Please seek an expert dermatologist for this.  I wish you the best of luck, Dr. Emer.

James C. Grotting, MD, FACS · Answer

Low doses of Botox (5 units) may be injected into the
depressor septi nasi muscle to help with nasal tip depression during
smile.  This needs to be performed very
precisely to prevent migration of Botox to the surrounding orbicularis
muscle.  Weakening of the depressor septi
nasi will not affect your flute playing or whistling, but weakening of the
orbicularis oris muscle can.  It is
important that you consult with a board certified plastic surgeon who is an
experienced injector to discuss Botox treatment to help with nasal tip
depression and improving a gummy smile.

Steven Wallach, MD · Answer

Some doctors inject the depressor septi to help with nasal tip depression. Gummy smile issues can also be treated with Botox.

Ramona Behshad, MD · Answer

Botox can be used off-label to inject underneath the nose to help lift 
the tip of a nose. This muscle is not important in smiling, whistling, or pursing the lips, so Botox will not have any appreciable effect on these actions if the correct muscle is relaxed. In addition, Botox injections are
temporary, only providing about four months of effect. This allays some of the concern for first-time patients. Fillers can also be injected into the nose to elevate the nasal tip, although this must be performed by an experienced injector, and dissolvable fillers should be preferentially used (hyaluronic acid).

Botox for depressor septi nasi muscle?

Answers (5)