Is This Still Swelling 1.5 Years After Rhinoplasty? Supratip Fullness and Smile Droop - how can I improve this? (Photos)

Question

Hello, I am looking for advice following a septorhinoplasty procedure I had in November 2024. I am now almost 1.5 years post-op and have noticed a small area of persistent fullness on the left side of my supratip. My questions are: -At this point in healing, could this still be residual swelling, or is it more likely scar tissue/cartilage asymmetry? -Would a Kenalog injection potentially help in this situation? -Are there any options that could improve this area? I also wanted to ask about tip drooping when I smile. I feel like my nose tip drops and the appearance changes significantly with movement. -Is Botox to the depressor septi nasi muscle commonly recommended for this? -If Botox helps temporarily, are there any surgical options to permanently address the muscle or improve tip support/drooping when smiling? -Would revision surgery ever be indicated for concerns like this, or is this usually managed more conservatively? Thank you!!

Waylon Zeng, MD · Answer

Hi thank you so much for your question and sharing your photos! At 1.5yr postop from septorhinoplasty, most, if not all, swelling has finally resolved. It's difficult to determine what that bump would be without feeling that area, but a bump that prominent would likely be either scar tissue or protruding cartilage. You have relatively thin skin on your nasal tip, so it is harder to disguise any subtle asymmetry between the left and right cartilages. 
Yes, typically what you are describing is overactivity of the depressor septi nasii. This can be managed by botox to the base of the nose septum (temporary) or also cutting the muscle from the inside of the mouth. Hope that helps!

Frank Agullo, MD · Answer

Calling it "still swelling" at eighteen months is the most common misread in revision rhinoplasty. The tissue is settled. What you're describing, supratip fullness and smile droop, is structural at this point, not residual edema.

The fullness is most likely a polly beak. The dorsum was lowered but the supratip cartilage didn't come down enough relative to it. You see a small bump above the tip when light catches it sideways. Thicker skin sometimes adds to the look with scar tissue underneath.

The smile droop is its own anatomic conversation. Usually a tight depressor septi nasi pulling the tip down on animation, sometimes a tip support issue from the original surgery that shows up only when the upper lip moves.

Kenalog and botox are both options, but both can be addressable in the same revision setting. Small dorsal touch, depressor release, sometimes a columellar strut. Find someone who does revision rhinoplasty as the bulk of their practice and bring your op note to the consult.

#StayBeautiful,

@RealDrWorldWide

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, it is difficult to know for sure but that may appear to be cartilage and then a revision would be best. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Milan Doshi, MS, MCh · Answer

Hi swiftlemon026At almost 1.5 years post-op, persistent supratip fullness is less likely to be simple swelling and may be due to scar tissue, thick skin, or cartilage/asymmetry. A Kenalog injection may help if scar tissue is the main cause, but it should be used carefully to avoid thinning or indentation.
For tip drooping when smiling, the depressor septi nasi muscle can contribute. Botox is often used as a temporary test and treatment. If Botox gives good improvement, a more permanent option may include depressor septi muscle release during revision surgery, often combined with better tip support if needed.
Revision is considered only when the issue is structural or persistent and conservative options are not enough.
This is a great question. I would recommend consulting with a board-certified plastic surgeon to further discuss your goals and evaluate you in person.

Is This Still Swelling 1.5 Years After Rhinoplasty? Supratip Fullness and Smile Droop - how can I improve this? (Photos)

Answers (4)

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