Downturned tip? Please do not recommend dorsal hump reduction (Photo)

Question

I really do not like the way my tip pulls down and looks bulky when I smile but I like the length of my nose and my small bump, I like having a prominent nose and I am not interested in completely changing the character of it. I just really do not like the lower third when I smile and want to know what, if anything, I can do about this? Thankyou

Jeffrey M. Darrow, MD · Answer

Yournasal tip appears to be in good position when you are not smiling, but is pulled down when you are smiling. If you gave your nasal tip additional support, with either a septal extension graft or a columellar strut, this would resist the downward pull when you smile and maintain your tip projection. No change to your nasal dorsum would be required. A small piece of your septic cartilage would be required. Speak to your plastic surgeon about these options.

John Michael Thomassen, MD · Answer

A tip rhinoplasty can be done to refine your tip without touching your dorsum.  A strut graft will support it so it does not descend when you smile.

Eric M. Joseph, MD · Answer

Since you like a prominent nasal profile appearance, after tip rotation, it would be important to keep the projection of your nasal tip so that your bump would become invisible. Consider visiting several reputable rhinoplasty specialist so you can see what to expect moving forward. Thank you for your question. Sincerely, Dr Joseph

Oakley Smith, MD, FRCSC · Answer

Hi, For sure you can do it, but It is better for you to consult with a facial plastic surgeon who can examine you and discuss the surgical procedure and the expected outcomes.

Zeshaan Maan, MD · Answer

It’s very possible to refine and reposition the tip without changing your dorsum or making your nose smaller. I recommend seeing a rhinoplasty surgeon for consultation to discuss your options.

Lexie Wang, MD · Answer

1) you could try botox first to see if you just want to change the tip drop when smiling
2) you can definitely do a surgery where all you do is  impact the tip/base of the nose and leave the dorsum alone (ie keeping the hump if you want it), you just need to be very clear with your surgeon about what your goals are and make sure that they know that they want you to leave the hump alone. I have done this before for 2 patients.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from a rhinopasty to help improve the support of your nasal tip. This will prevent the drooping when you smile. 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

Thomas Spalla, MD · Answer

Something you may wish to consider is a trial of Botox, or other neurotoxin, to alleviate the dynamic downward pull that occurs with smiling. If this works, and you wish only this change to occur, then transection of this muscle may bring about all the change you need while preserving the remainder of your nasal appearance.

Adnan Fuat Buyuklu, MD · Answer

Hello, If you do not like only the lower third of your nose, we can modify only the tip area of your nose with "nasal tip surgery". Only the nasal tip area will change without touching the bony roof of your nose. A non-surgical option (which has limited effect) is to paralyze the muscle (depressor septi nasi) that pulls the tip of the nose down with botulinum toxin, thus preventing the tip of the nose from being pulled down to some extent while laughing and talking.

George Lefkovits, MD - Account Suspended · Answer

You can correct the downturned tip without necessarily  correcting the other features of the nose. But you really need to consult with a Board Certified plastic surgeon with lots of experience performing nasal surgery.

Downturned tip? Please do not recommend dorsal hump reduction (Photo)

Answers (10)

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