Injecting Botox to Deactivate Depressor Septi Nasi Muscle After Revision Rhinoplasty

I had revision rhinoplasty ~20 days ago. First time my tip dropped. Now it has been lifted. I expect it will drop (I can tell!). My tip drops when I smile (or speak). The septi nasi muscle was not addressed (cut) during revision. I'm just wondering if I can use botox to deactivate this muscle, so that I avoid that downward forces (i.e., from smiling) help in dropping the tip. I'm trying to prevent!. If so, how soon after rhino can I be injected with botox (to deactivate septi nasi)?

Doctor Answers 5

Botox Helps Rhinoplasty Results

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Some patients have a small muscle at the bottom of the nose, that pulls the tip of the nose down when the patient smiles. When performing an examination during a rhinoplasty consultation, patients are evaluated for this condition. The muscle can be clipped during surgery. If it was not diagnosed , certainly Botox placed even before the surgery can help. It could be placed anytime after wards as well. I do not recommend BOTOX in the operating room, as it does not seem to last as long. We know the muscle has to actively be used to help pick up the BOTOX, with the patient asleep, the muscles cannot fire, and the BOTOX may not work.

 Tip droop  after surgery can be related to a variety of factors, thick heavy skin, loss of bony support, failure to secure the tip complex to the end of the septum, etc. Be sure to discuss your concerns with the rhinoplasty surgeon, and make sure they are a specialist in revision rhinoplasty.

Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

Botox after Rhinoplasty

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Yes you can have Botox treatment at your soonest appointment with your surgeon. The Botox can be used for the depressor septi nasii and will help prevent the tip being pulled down during the recovery phase. I use Botox in a lot of facial procedures during the recovery phase to help ensure the muscles stay relaxed and allow the proper healing. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Botox Post Rhinoplasty to Prevent Downward Pull on Nasal Tip

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Hola Mex,

You can have your Botox treatment to relax the depressor septi nasalis muscle as soon as you can get in to see your physician.  Discuss this with your rhinoplasty surgeon. Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

BOTOX does help rhinoplasty healing

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You are correct in that BOTOX can prevent muscles from pulling the tip of your nose down.  Theoretically, it could be injected as early as a week before the surgery.  BOTOX is often used in other areas of the face during healing to relax muscles and allow surgery sites to heal without tension.  Relaxing the muscles around the nose could allow the tip to heal in an elevated position.  Hopefully you will not need the injections for life - just until good tip support can be established.  It is definitely something to discuss with your surgeon - who knows your nose.  Without seeing you before and after surgery, it is difficult to make firm recommendations.  It is also difficult to predict final results from rhinoplasty in the first few months of healing.  Your best course is always to communicate well with your surgeon and work together to achieve the results you want.

David Magilke, MD
Portland Facial Plastic Surgeon


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Botox can be used for the depressor septi nasii. This will prevent the tip from droping on smiling and animation.

If you like the results then the depressor nasii can be cut and approximated together through a small cut in the sulcus of the upper li. This can be done under local anesthesia, as out-patient procedure.

Samir Shureih, MD
Baltimore Plastic Surgeon

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