Only cutting "Depressor septi nasi muscle" - tip of the nose will droop after surgery?

The depressor septi muscle is commonly modified by plastic surgeons during rhinoplasty, especially if one has a droopy tip when smiling. This muscle can be treated alone or combined with other procedures during the rhinoplasty (ex. cartilage grafts, sutures, etc). An alternative is to soften the muscle with Botox injections, but non-surgical rhinoplasty is temporary and more subtle. We've reviewed a droopy nasal tip in our blog post. If you haven't already, then speak with a rhinoplasty surgeon to review options.Best, Dr. Chabnoki

Some surgeons like to release this muscle to prevent nose drooping while smiling in their nose surgeries.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search. 

The pull on the nasal tip on smiling is what gets better the most with cutting this muscle. If your main concern is the tip projection at rest then a coulmellar strut is a better option. RegardsDr. J

A surgical rhinoplasty is a powerful procedure that adds, removes, or re-positions tissue in the nose for better aesthetics - often completely reshaping the nose. This often involves removing dorsal humps, making the nose straighter, and refining the tip. 
Based on your complaints of motion of the tip with smiling, your concerns may be helped by cutting the depressor nasi. Every nose is different, however, and additional support of the tip may be needed to stabalize the tip achieve your ideal result. 
For more info on rhinoplasty, see the link below.

A detailed examination will help delineate the best surgical option and provide you a custom quote for your situation. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

Hello and thank you for your question.  The best advice you can
receive is from an in-person consultation.  Transection of the depessor nasi septi muscles can definitely help with the depressed tip.  I usually perform other maneuvers as well such as angulated caudal septal resection and cartilage grafts, depending on the nasal anatomy.   Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and not just a computer animation system. The most important
aspect is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon
 

Dear UltimaWH in New York, NY:
So, your nose droops when you smile.   If you release the depressor septi muscle that may not happen.  The muscle is released by making an internal nasal incision.  No need for an outside incision and a columellar strut may not be necessary.  There are patients who have only release of the depressor septi muscle and they are very happy with the results.  No architectural changes to the nose need be done. 

I suggest you have consultation with very experienced, superspecialized rhinoplasty surgeons.  The time you spend doing the homework and research will pay off.  Visit websites, see the results of the work.  A close review of the before and after gallery is very important. 

Best wishes,

Robert Kotler, MD, FACS 

In our practice count, cutting the depressor septi ligament is done as part of a rhinoplasty procedure. Releasing the ligament prevents the tip from drooping when smiling.

There was a recent journal article suggesting that tip depression when smiling was mostly an illusion as the other tissues pull up with smiling. I do  not routinely treat the depressors for the downturningtip.  I usually treat the tip directly.

Cutting the depressed septi muscle helps with the dynamic 'droop' of the nasal tip with smiling, but by itself does not provide the support that most patients with poor tip support are seeking. To answer your question, I don't believe that cutting the muscle makes the tip support worse. In my practice, I routinely combine cutting the depressor with adding columellar strut grafts to improve tip support to achieve the desired result in this scenario. Best of luck and be sure to discuss this with your surgeon.