Drooping Tip When I Smile - Post Rhinoplasty (Photos)

Question

My bridge was lowered and my tip was rotated “up” from the original position. I’m about 6 months post op and I’m really disliking how my nose angles down when I smile still. My depressor septi was cut during surgery, so that isn’t the cause. Is this due to my facial anatomy/cheek muscles, or is this something that can be fixed? I just want my tip to stay straight when I smile. I’d prefer if it didn’t move at all to be honest.

Oakley Smith, MD, FRCSC · Answer

Hi, It is better for you to consult with your facial plastic surgeon who can examine you and give you opinion based on examination.

Lucian Ion, FRCS · Answer

Thank you for your question and for sharing your photographs. The shape of your nose at rest is pleasing; however, it appears that the support of the nasal tip is slightly flexible. This flexibility can be attributed to the moderately soft cartilage in the nasal septum and tip, where even a septal cartilage graft might not fully stabilize the tip.

In such cases, using rib cartilage for tip support is generally more beneficial because it provides more robust structural control. Additionally, elevating the tip-defining points slightly—without further shortening the tip—can offer extra protection against the impression of a downward-pointing tip. This is particularly relevant when smiling, as the nostrils move upward, altering their relationship with the nasal tip. By positioning the tip-defining points higher, the dynamic interplay between the nostrils and tip is maintained, reducing the likelihood that the nostrils appear to be sitting above the tip.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.
As far as I can see from your photos It is possible to increase the projection a little more and raise the tip of your nose, but I recommend you to wait 1 year for this.
It would be better face tl face consultation.
Best Regards!

Eric M. Joseph, MD · Answer

Some people require more tip support than others, when dealing with the correction of a droopy nasal tip appearance with rhinoplasty surgery. We utilize columella strut grafts, which is like a Matchstick size piece of cartilage, to be implanted in somebody's nasal tip to add structural support. Severance of the depressor septi muscle may not completely adequate, and we do not implement this in any of our patients. The best advice I could give is to visit a reputable rhinoplasty specialist for an opinion about your situation. Thank you for this question. Sincerely, Dr Joseph

Stephen Prendiville, MD · Answer

The static appearance of your nasal tip at rest appears to be quite good. The goal of Rhinoplasty is more for nasal position at rest than when smiling. Since you have a beautiful smile, and your smile dynamics affect the nasal tip, this would have to change to achieve your goals.You can make the case that perhaps the dorsal and caudal septum could be reduced a little further to give a slight retroussee, but many of us who perform a lot of rhinoplasty feel that a straight dorsum looks better over time. Certainly, discuss your concerns again with your surgeon, and if not satisfied, seek another consultation.

Bianca Knoll, MD · Answer

thank you for posting your question.  The drooping when you smile is very minimal and looks really natural. It is normal for the nasal tip, and alar to move when our mimic  muscles are active. The surgical result of your rhinoplasty looks very natural and not operated. I would give it some time and wait until it is fully healed to discuss the result with your surgeon. S/he will certainly be able to address your concerns.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty to help stabilize your tip to help prevent droop with animation. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers.. 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

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!It is hard to tell the reason for the change in tip position without an exam , but from the pictures it looks like it's just the ala moving superiorly and flaring when you smile rather than the tip going down , but it is hard to tell without an exam. other reasons could be that the depressor was not cut or was not redirected so it just healed back , or that you lack the support in the tip which renders it weak and gets depresses on smiling. Whatever the case is , I would encourage you to discuss your concerns with your surgeon so they can come up with a plan that works for you .

Barry M. Weintraub, MD, FACS · Answer

I have studied your photos and not only do you have inadequate tip projection, but upon smiling the nose takes on a convexity and points downward, which is the opposite of what one would like to see in a postoperative result. In my practice, one of my first and foremost goals is to create excellent tip projection and definition, particularly upon smiling. In my experience, cutting the nasal depressor muscles is not effective. To explain the overall anatomy and goals:  the nasal bridge should begin opposite the blink crease of the eyes, and end right before the tip begins -- or in other terms, in the "pre-tip" area. The tip should stand up alone with beautiful projection (at approximately 92 degrees from the upper lip). The tip should be detailed but not skeletonized . Upon smiling, it should not become downturned. This can be accomplished by inserting a columellar strut, or a septal-extension graft, which therefore guarantees tip projection in repose and during smiling. Thank you for your inquiry, and I hope this helps you.

George Lefkovits, MD - Account Suspended · Answer

Your photos do not really tell the full story. It is possible that a tip graft would be able to address the issue which it does in most cases. It would also lead to more definition to the tip. You really need to be examined in the office to best assess the concern and address the problem. You should consult with a Board Certified plastic surgeon with lots of experience performing nasal surgery. Good luck!

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