My Nose Points and Flares when I Smile, How Can I Change This? (Photos)

When I am not smiling I have this cute button nose, but as soon as I smile my nose flares and overly points it looks awful!! I would like to know what kind of procedure can correct it without ruining the button part when not smiling.

Doctor Answers 5

Tension nose correction

Hi there,

This is a common problem . You have a tension nose. This just means that when you smile a little muscle joining the lip to the nose activates and pulls it down.

It can be corrected by a little bit of botox placed just at the bottom of the columella of the nose.  Worth starting with that.  It might have a secondary effect of making your upper lip feel a bit less "controlled" and not everybody likes that, but if you don't it will wear off and just don't repeat it.  If you like it, you'd need it repeated either twice or three times per year. It would only need 2 or 3 units, so is a cheap solution.

It's a simple problem to fix surgically.  There is an incision placed across the columella base.  The muscle is divided.  Usually I fix the medial crura of the alar cartilages to the lower septum to further brace the nose tip in case the muscle reattaches itself which it can.

Good luck!

Nasal "flare" with smile

This type of change with smiling is not uncommon and can be corrected with what is called Weir excision.  In this procedure the base of the nose is tightened so that smiling does not result in so much spreading of the base.  Weir excisions do not create significant visible scarring.  The procedure can be tailored to the individual patient. 

This can usually be performed in the office under local anesthesia.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 44 reviews

My Nose Points and Flares when I Smile, How Can I Change This?

I have performed Rhinoplasty for over 20 years and IMHO,  from the photos provided the nose has a wide tip and flared nosrtils that is indeed more pronounced with smiling.  While, the shape of the nosrtils where they attach to the cheeks can't be adjusted without the possibilty of unsightly scars, there are ways to improve the appearance of the nose in general.

  1. Open Rhinoplasty to refine and strengthen the nasal tip cartilage support.  When smiling, the nasal tip support is further weakened allowing the nostrils to spread.  A conchal cartilage ear graft may be required to add additional nasal tip support.
  2. Internal Weir incisions to reduce the size of the nostrils.
  3. A specific tip technique used in combination with an Open Rhinoplasty called "lateral crural flap" that refines, thins and adds support to the nasal tip while bring in the nostrils towards the midline.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

It's worth giving Botox to try

There are muscles that pull the nasal tip down as well as pull the nostrils laterally. I've had good luck with injecting a few units of Botox into specific areas around the nose to soften the pull of these muscles. The effect lasts about three months and it is not very costly.

Surgically, you can decrease the size and reshape the nostrils as well as trim the muscles causing the lateral pull for a more permanent effect

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 20 reviews

Flared nostrils and tip depression with smiling

Everyone's nose gets wider with smiling, but it tends to be more noticable in patients with already relatively flared nostrils at rest. Surgery can reshape the nostrils so that they are less flared. When expertly performed, the incision is usually almost invisible. There is a muscle that brings the tip down with smiling that can be cut to correct that issue but sometimes it reattaches.

Edmund Fisher, MD
Bakersfield Facial Plastic Surgeon
4.6 out of 5 stars 13 reviews

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