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?

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.

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

Jose Perez-Gurri, MD, FACS · Answer

Hi and thanks for sharing your photos.  I know you may not think so but it's actually not too difficult to correct. The nose is comprised of certain components, skin, cartilage, mucosa and bone. Whenever any of these individuals  components are a dealt with,  they affect the others and there is a domino effect. Whomever you finally chose,needs to be very well experienced in cosmetic rhinoplasty . The surgeon needs to realize that cosmetics surgery of the  nose is the most complex in nasal anatomy. there is nothing worse than  to have good looking nose from which you can't breathe. The face is divided into thirds. The first third extends from the hairline to eye level. The second from eye level to the upper lip and the lower third from the upper lip to the chin. What we look for is a harmonious profile, that is a balanced profile. Sometimes all that it takes is rhinoplasty, sometimes a rhinoplasty with chin implant and sometimes just a chin implant. This seems to be the case with you. I perform all of my chin implants through a buccal incision, that is....through the inside of the lower lip. I prefer this approach because all too often I have seen chin implants displaced downward when the incision has been made under the chin.There are many surgeons that are very successful with this method and as for me, it's a matter of personal preference.I encourage you to look up the surgeon you eventually select and make sure they are certified by the American Board of Plastic surgery and have years of experience in performing chin implants. Furthermore, request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits? Good luck.I wish you the best on your journey. I hope that the info provided has been helpful. Should you require any further clarification, do not hesitate to contact us. I personally conduct all the consultations and formulate an individual operative plan based on physical findings. We are one of only a few in South Florida that employ a web based program called TouchMD. Through this program potential patients from as far away as California can upload their photos. I then review each and everyone and draw my recommendations on your actual picture. This info is made available to you with the use of a private password that only you will have. TouchMD is private and follows all applicable privacy laws (HIPPA). I answer all questions personally, not through patient coordinators or other marketing individuals. Good Luck Dr. PG

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.

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.

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

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.

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