I have a drooping tip when smiling. How can it be corrected? I'd like it to look more feminine

Question

How can the drooping tip when smiling be corrected? I had revision rhinoplasty seven years ago and have struggled with the outcome. A cartilage graph was used to correct a ski slope. When I smile it widens across my face and droops. It looks bulbous and bumpy, too. As for taking photos, well it is not pretty at all. What is the issue that you can see and how can it be corrected. My surgeon was high profile revision specialist in Beverly Hills. He suggests that I leave it alone. HELP.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about revision rhinoplasty.The photos are limited, but in one of the pictures the cartilage graft seems prominent.To be sure, see two or more experienced, board-certified Plastic Surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have revision rhinoplasty surgery.I hope this helps.

Kimberly Lee, MD · Answer

This is a common request from patients who find that they have drooping of the nasal tip with smiling or talking and can be easily addressed.  The best recommendation is to have an in person consultation with a board certified specialist who can evaluate you and assist you with achieving the goals you seek. 3-dimensional computer imaging can help you visualize what you may look like afterwards and serve as an important communication tool with your surgeon.

Andrew S. Frankel, MD · Answer

Without knowing what your nose looked like before your last surgery it is difficult to say whether the benefits of another surgery will be worthwhile. Weighing the risks and benefits would also depend on precisely what was done at your last operation. I can see the outline of a graft in your tip and it might be best to remove that graft in order to debulk your tip (but the shape of your original domes are like might require some type of camouflage to remain in place.) The droopy tip must be assessed in person as it's dynamic in nature.There is some modest asymmetry at your nostrils that may also benefit from correction.I suggest you have a few consultations with qualified revision nasal surgeons in order to come to a decision.

William Portuese, MD · Answer

A rhinoplasty procedure can accomplish reduction of the bulbous tip with a combination of conservative cartilage removal will and suture techniques applied to the lower lateral cartilages of  tip. To prevent the tip from drooping when smiling, releasing the depressor septi ligament is required.

Michael Elam, MD (retired) · Answer

Dear lavitadulce, Yes your nose can be corrected with revision surgery. An examination and copy of your operative report would be helpful in determining what would be the most beneficial course of action to make sure you have a desirable result. Digital imaging can be performed which will show you the proposed result so that you may make a very informed decision regarding revision rhinoplasty. Best regards, Michael V. Elam, M.D.

Richard W. Fleming, MD (retired) · Answer

Your wide bulbous tip, present when at rest or when you smile, can be reduced and refined. The  increased width with facial animation can be decreased by narrowing the flared nasal base. Drooping can be restricted by  cutting the depressor septi muscle. I understand your frustration; with these changes your nose can be feminized to match your surrounding facial features.

I have a drooping tip when smiling. How can it be corrected? I'd like it to look more feminine

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