What Procedures and Cost Ranges Would Be Suitable to Alter my Commonly Labelled "Witch's Smile" and "Moustache Fold"? (photo)

When I smile a lot of gum shows at the top, my teeth stick out, are crooked, gappy and chipped. My front teeth are much longer. Lower lip protrudes a lot, with pronounced nasolabial folds. I get a deep fold in my skin between my upper lip and nose which causes shadow, so I get: "It looks like you have a moustache when you smile!" The tip of my nose droops down and the hump on my nose hooks over, making me look "like a witch" when I smile. I'd like to know what my options are for future. Thanks!

Doctor Answers 4

What Procedures and Cost Ranges Would Be Suitable to Alter my Commonly Labelled "Witch's Smile" and "Moustache Fold"?

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         A rhinoplasty can address the tip droop and the hump on the nose.   Find a plastic surgeon with ELITE credentials who performs hundreds of rhinoplasties and rhinoplasty revisions each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA

Nose and smile

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If you do not want a rhinoplasty to correct your dorsal hump and improve your tip/lip angle, then a small amount of Botox at the base of the nose and perhaps some fillers in the nasolabial folds may do the trick.  Of course, an evaluation in person is essential.

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

Gummy Smile and Nasal Tip Droop Correction

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You are exhibiting two distinct but anatomically close problems. You have a slightly downturned nasal tip with a hyperactive nasalis muscle which pulls down on your nose as you smile. To change that effectively long-term, you should have a nasal tip adjustment that corrects the natural downturn to your nose. You also are showing a gummy smile with animation. By doing an internal mucosal V-Y advancement with upper lip medial elevator muscle release, the central part of the upper lip will not pull so far to the sides revealing too much tooth and gum show. The nasal muscle could also be released at the same time which would also help the pulling on the nasal tip.

Gummy smile

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Speaking entirely personally I think you look great and have a lovely smile.  Though the nose seems to have an operable configuration, the other things that bother you like the gummy smile are not so easy to take care of as they are animation issues, not static ones. 


Botox has been used in small amount in the upper lip to make the gumminess better. If you don't like it at least it will go away. 

Val Lambros, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 8 reviews

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