Can You Fix a Droopy Tip/curved Nose (More when Smiling) with a Hump Removal and Radix Graft?

I'm asking this question because my nose is curved and tends to look more curved when I smile and the tip droops. My doctor is performing a closed rhinoplasty and he is going to add a radix graft and remove the hump. He also said something about performing osteotamies. I want to know if this does anything to solve the problem of a curved nose while smiling.

Doctor Answers 5

A rhinoplasty without muscle release may be unsatisfactory.

You have described a common situation in which the depressor septi muscle, arising the lip and attaching to the nose, is active. So, when some people smile, the nasal tip depresses and makes the nose look longer.  Smiling may also widen the nose, but that cannot be corrected by standard surgical procedures and is not advised.

Regarding removing the hump and then adding a Radix graft: I cannot comment on that, except that, frankly, such surgical maneuvers increase the uncertainty of the outcome.

In my experience, if the tip depresses with smile -- and that is your major point of concern -- consider the simple and "done under local anesthesia with sedation" solution, which is releasing the depressor septi muscle through a closed rhinoplasty approach.

Robert Kotler, MD, FACS
Facial Plastic Surgeon

Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 85 reviews

Drooping tip and closed rhinoplasty

Rhinoplasties can be performed open or closed. A droopy tip is treated based upon the cause. Sometimes tip sutures combined with caudal septal excision can help. Best to be seen in person to be properly evaluated.  

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Droopy tip

A droopy tip that curves more when smiling will have a problem with the underlying structure.  This will need to be addressed at the same time as the other alterations to your nose are being done.  The tip will need to be supported with a  cartilage graft of some sort (tip strut, extended spreader graft, etc).  Clarify this with your surgeon.

Douglas J. Kibblewhite, MD
Vancouver Facial Plastic Surgeon

Correction of droopy tip

Correcting a droopy tip requires support, usually in the form of a columellar strut, caudal extension graft, or a tongue in groove technique.

Andres Bustillo, MD, FACS
Miami Facial Plastic Surgeon
4.9 out of 5 stars 115 reviews

Rhinoplasty for a droopy nose

Dear RHello321,

  • To fix the droopy tip, you need to reinforce it with cartilage grafting
  • You should ask your surgeon if he/she plans to do that
  • Ostetomies are meant to reset the nasal bones to make the nose thinner on frontal view
  • The radix graft and hump removal only fixes the bridge of the nose
  • If you have any concerns, you should bring them up to your surgeon or go to a second consultation
  • If you would like an example of fixing a droopy tip using the closed approach, please message me and I will send you a before and after picture

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.