My Nose Expands and Looks Really Big and Flat when I Smile. Is There a Way to Fix That Without Losing Its Character? (photo)

Question

My Nose Expands and Looks Really Big and Flat when I Smile. Is There a Way to Fix That Without Losing Its Character?

Albert W. Chow, MD · Answer

Hello,I saw your picture and although they are only a representative of what I may see in person, I think you have to be careful in making changes to your nose.  It is a part of your body that is a focal point on appearance but caution needs to be taken in that changes that may affect the appearance can have consequences in function such as breathing and smell.  Smell is a function that can affect taste.  Many techniques that are used by surgeons to narrow a nose both at the tip and nostril tend to reduce the free flow of air through the nose.  An expert rhinoplasty  surgeon with significant experience  can give you the best functional and aesthetic assessment of your situation and give you the most accurate expectation of results should you pursue surgery.  Thick skin does not lead to fine detail in the tip area and nostrils can look unnatural if a routine alar wedge is removed.  There are techniques that can be performed to improve these areas without an unnatural look.

David Mattos, MD · Answer

Great question. There are a lot of muscles on the face that are involved in smiling, and some of those muscles also connect to the sides of the nose. Therefore, when we smile, it pulls the nose up and outward, and every nose gets wider when the person smiles. Some get wider than others, and some of that depends on the laxity of your skin, cartilage, width of the nose, etc. From the photo it appears that you have a wide alar base. This is something that could be corrected surgically if it is particularly bothersome to you, but I would discuss your goals with a plastic surgeon and see if he or she thinks it's possible to give you the outcome you are seeking. 
-Dr. David Mattos, New York Plastic Surgical Group

Robert Kotler, MD, FACS · Answer

Dear Hanne91;

	Your nostrils are quite wide and the overall width of your nose, compared to the entire width of your face, is rather significant.  Smiling probably makes it worse because the cheek muscles pull the wings of the nose up and out to further widen the nose.

	If your bridge is low, you may be well served by having the bridge improved either using natural tissue or an artificial bridge.  And there may be a place to narrow the floor of your nostrils.  Likewise, the tip might stand a little narrowing.  However, none of those things will prevent the nose from widening with smile.  Remember, other people have a problem where the tip of the nose depresses with smile; that is correctable.  Unfortunately, one cannot sever or paralyze the muscle that tend to widen the nose when smiling. 

	Robert Kotler, MD, FACS
	Facial Plastic Surgeon
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
	Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Aaron Stone, MD · Answer

Your photo shows a flattened bridge and most likely a wide alar base. The standard approach to narrow and project the nose out of the plane of the face is a bridge implant or graft and narrowing the base width. I do not know what you mean by character of the nose. If the look/shape is changed I would think you would consider the character changed as well as the ethnicity to some degree. You could opt to leave the tip and base unchanged if you want a less dramatic difference.
	
	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
	
	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Richard W. Fleming, MD (retired) · Answer

I'm sure that your nasal tip is big and flat when you are at rest, but becomes worse with facial animation and smiling. The tip and the nasal base can narrowed and and the tip can be augmented to increase projection and definition. It is normal for the nose to change when smiling.

My Nose Expands and Looks Really Big and Flat when I Smile. Is There a Way to Fix That Without Losing Its Character? (photo)

Answers (5)

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