Why does my nose hang when I smile and what can be done to fix it? (Photo)

Question

The tip of my nose is too close to my top lip and hangs down. When I smile my nose curves downwards and my nostrils are very long. What kind of surgery should I look into?

Deepak Raj Dugar, MD · Answer

Hello,Droopy tip (or Hook nose) is one of the most common reasons patient seek out Closed Scarless Rhinoplasty. This can be a concern when at rest or even worse when smiling. he key is to rotate the nose upwards and prevent the excess pulldown when smiling. We utilize multiple maneuvers to carefully rotate the tip of the nose to lift it to an elegant height and design without any telltale signs of surgery. A closed scarless rhinoplasty is the best surgery to fix this. By doing this via a scarless (closed) approach, there are no external cuts ever on your nose.  This prevents the dreaded complication of external scarring at the base of the nose, which even if rare, if it occurs, is devastating.  Through a scarless approach you can accomplish almost everything needed to be done to the nose with no scarring, less healing time, less bruising, and less swelling. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

William Portuese, MD · Answer

A rhinoplasty procedure can address lifting the drooping tip and prevent it from its drooping with smiling and animation. Closed rhinoplasty techniques can accomplish the goals of dorsal hump reduction, and lifting the tip. The columellar show show can also be reduced. It's also important to release the depressor septi ligament which pulls the tip down with smiling.

Afshin Parhiscar, MD · Answer

Dear Potts94You are a great candidate for a rhinoplasty. Although specifics can be tailored to your personal preferences, changing the shape of your dorsum, shortening and de-rotating your tip and providing long term structural support while doing these through a closed rhinoplasty with not only give you a great nose that doesn't "curve down" but will also bring nice balance to your face, with a better proportion between your chin and upper lip and a nicer profile.A consultation with a surgeon, Board certified by the American Board of Plastic surgery, who is experienced in rhinoplasty would be your next best step if you want changes in the shape of your nose.

David W. Kim, MD · Answer

Your concern is a common one that I see in patients.  In everyone, the nostril insertion on the cheek elevates and widens with smiling.  This is because the smile muscles pull the nasal base up with the corners of the mouth when they are active.  Because the nostrils rise, it creates an appearance that the tip is lower.  In your case, your tip also does descend a bit with your smile.  This is a separate issue caused by a depressor muscle in the upper lip. I believe surgery is the best way to reliably treat this.  Adding support to the tip with structural rhinoplasty to strengthen and elevate the tip will make your nose look more feminine and better proportioned.  The structural graft that is added to the tip will also make it less prone to drooping with smiling.

Thomas Trevisani, MD · Answer

Every human being has a distinct structure to their nose. Your cartilage needs to be trimmed in all of its aspects. This can be done through the closed technique-- the incisions will be internal to your nose. I don to believe you will a scar in your columella. You should expect a very acceptable result through this technique. I would strongly recommend a qualified Board Certified PS who can demonstrate a wide variety of before and after photos for your review.

Elliot M. Heller, MD · Answer

What you want done is completely up to you. Maybe a Rhinoplasty, Rhinoplasty typically starts at $5,500 depending on the area you live. To make sure you get the best possible result, the surgeon should perform a detailed exam of the nose and provide a realistic goal that you and your surgeon agree upon. Rhinoplasty are permanent, but with age facial features do change. Find a surgeon and go for a consult, I think you would be very happy after the surgery.

Stephen Weber MD, FACS · Answer

These are very common concerns. The tissue between your nostrils (columella) hangs lower than it should. This is enhanced when you smile since the depressor muscle pulls your tip further down. These issues can be addressed during typically rhinoplasty surgery. Any other concerns that you have about your nose size and shape, if any, can also be addressed at the same time. Consult with a plastic surgeon who chooses to make rhinoplasty the focus of their practice. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Jennifer Parker Porter, MD, FACS · Answer

When the nose moves in a downward direction with smiling, this is due to a fairly active muscle located in the area between the nostrils.  Improvement in this can be accomplished with a little Botox to weaken the muscle. The injections would need to be done every 3 months to continue the improvement.  The other option is surgical.  A rhinoplasty could address this issue and reduce the excursion of the nose with smiling.  A rhinoplasty could also adjust the distance between the tip of the nose and the lip. Of course the rhinoplasty would be a more permanent solution and would address any other concerns as well.

Michael L. Schwartz, MD · Answer

You have a short upper lip, drooping tip and excess columella show presumably from a long septum if you have never had previous surgery. A rhinoplasty that would improve your tip projection relative to your dorsum, support your tip and improve your alar columellar proportions would solve your issues. You likely would see a wonderful result. Go for some in person consults with computer imaging and learn more.

Michael T. Somenek, MD · Answer

This is mostly due to a nasal muscle at the base of the nose that can exaggerate a drooping tip when smiling. This can be addressed during a rhinoplasty where the muscle is cut to prevent this from occurring postoperatively. Hope this helps.

Why does my nose hang when I smile and what can be done to fix it? (Photo)

Answers (13)

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