Can Rhinoplasty Improve a Low Smile Line and Increase Upper Tooth Show?

Question

I have a bulbous nasal tip that points downward quite noticeably when I smile. Because of this, my upper lip covers a significant portion of my upper front teeth, resulting in a relatively low smile line. I am planning to have a rhinoplasty and was wondering whether lifting the nasal tip during the procedure could also improve my smile, allowing more of my upper teeth, and ideally a small amount of gum, to show when I smile. I have noticed that when I lift my nasal tip upward with my fingers, my upper lip also lifts and significantly more of my teeth become visible. This makes me wonder whether the position of my nasal tip may be affecting my upper lip movement when I smile. Could this potentially be corrected as part of a rhinoplasty? If not, are there any other procedures or treatments that could be performed in addition to rhinoplasty to address this? I would preferably like to avoid a lip lift because I do not want a scar or to change the overall position of my mouth. The issue seems to be that the inner part of my upper lip covers my upper teeth when I smile (in the middle). I would really appreciate any advice from surgeons who have experience with this type of issue.

Jeffrey H. Spiegel, MD · Answer

I did the original work demonstrating rhinoplasty and lip lift together. These are safely done together. However, a rhinoplasty alone is unlikely to change your lip position in a meaningful way.

Semih Yildiz, MD, FEBOPRAS · Answer

Lifting the nasal tip during rhinoplasty can change the relationship between the nose and upper lip, but it usually does not directly raise the upper lip or reliably increase tooth show. In my experience, the smile pattern may also reflect upper-lip length, levator muscle activity, dental or gingival display, and how the tip moves during smiling. Rhinoplasty can address a drooping tip when that is part of the nasal anatomy, but any change in the smile should be considered a secondary and less predictable effect. An examination with dynamic smiling photos or video is needed before considering an additional lip or muscle procedure.

Zoran Potparic, MD · Answer

Without photos it is very hard to give a good advice. In general, rhinoplasty and lip lift should be the option. These two procedures may be done in the same time or separate, as some surgeons like to do. I hope this helps. Good luck.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. It would be helpful to see pictures of your nose. There are several maneuvers that can elevate and stabilize a drooping nasal tip. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. With good surgical technique, you could likely have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D. FACS
Harvard-trained board certified plastic surgeon

Yasemin Aydinli, MD · Answer

Your observation is a real one. When the nasal tip droops on smiling, the depressor septi muscle pulls the tip down and shortens the upper lip at the same time, so lifting the tip with your finger releases that pull and shows more teeth. During rhinoplasty this muscle can be released and the tip supported and rotated so it no longer drops when you smile. In most patients this gives a modest improvement in upper tooth show, usually a few millimeters, and it can also soften the horizontal crease some people get above the lip. What it cannot do is lengthen or lift the central lip itself. If the main issue is a long or heavy upper lip covering the incisors at rest, the true corrections are a lip lift or, in selected cases, orthodontic or skeletal treatment, and you have already said you want to avoid the lip lift.

Can Rhinoplasty Improve a Low Smile Line and Increase Upper Tooth Show?

Answers (5)

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