The bottom of my nose impeads my smile. I get an odd 'u' shape. How to correct this? (photos)

Based on these photos and your short history, you seem to be excellent candidate for rhinoplasty. In the hands of an experienced, board certified plastic surgeon, expert in rhinoplasty, both nose and lip deformity should be properly addressed. Good luck.

This is a common finding in people who have larger noses. The lower part of your nose (caudal septum, columella) are prominent, causing the crease. Another thing to answer is if you've have any nasal fillers (liquid rhino). I see this often in patient's who had filler injected at the base of their nose. Best treatments are rhinoplasty and release of the depressor septi muscles. If you've had filler - I'd recommend melting it with hyaluronidase before the rhinoplasty.

The nasal tip and lip: from the pictures you show it appears that you have a short upper lip. In people who have a short upper lip in whom the lip pulls the tip down when smiling and the nose correspondingly pulls upward on the tip this is referred to as a tethered lip. This is addressed during rhinoplasty by reducing a structure called the nasal spine and dividing the muscle connecting the lip to the nasal septum .

A closed rhinoplasty approach can accomplish shaving down the prominent nasal spine, and reducing the hanging columella in addition to shaving down the dorsal hump and narrowing the bridge line. All the incisions replaced on the inside of the nose. No external incisions are required.

Every nose is different and unique to that individual. If the appearance of your nose concerns you enough to do something about it, it can be improved with a natural artistically performed rhinoplasty. What would be the best option and exact procedure would depend on an in person examination (not just an online consultation) and discussion about desired outcome. Excellent results can be achieved with either a closed or open technique.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do and how technically to do it based on limited photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of the operative procedure would not be in your best interest. Natural appearing results need to be individualized and what is appropriate for one patient is not necessarily the best for someone else. I would suggest that you find a surgeon with extensive rhinoplasty experience certified by the American Board of Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla, California