Nose turns down when I smile - Would a rhinoplasty help? (Photos)

Question

I never completely hated my nose till recently i have been fixating on it. Ive always been self conscious of my smile due to my teeth not showing well. I really don’t want to do veneers but someone had mentioned a rhinoplasty may help due to being larger compared to my other features. I am really scared to do a rhinoplasty bc ive heard mixed reviews but when i smile i fixate on how my nose turns down and my bump.

Semih Yildiz, MD, FEBOPRAS · Answer

The neutral and smiling profiles show a mild dorsal convexity and some downward tip movement with smiling; the frontal images do not make the nose look clearly out of proportion, though photographs and expression can distort scale. Dynamic droop may reflect tip support and the pull of the depressor septi muscle. A carefully planned rhinoplasty can soften the hump and strengthen or reposition the tip so it moves less when smiling, while keeping the result natural. In selected patients, treatment of the depressor septi is considered, but it can affect upper-lip movement and should not be used automatically. Rhinoplasty is not a predictable treatment for limited upper-tooth show. Tooth display also depends on upper-lip length and mobility, tooth position and size, and the maxilla, so an orthodontic or dental evaluation may be more relevant than veneers. Because this concern has become more noticeable to you only recently and surgery feels frightening, there is no need to rush. A facial plastic surgeon can compare standardized neutral and smiling views or video, examine tip support and breathing, and show a conservative simulation before you decide whether the likely benefit is worth the surgical risks.

Gianfranco Frojo, MD · Answer

If you wantto address any nasal features, a rhinoplasty is always the best option. You should go see a surgeon in person to really get a full evaluation and physical exam. I would maybe consider several opinions to help narrow down what you are truly seeking. You need a real plastic surgeon expert certified by the American Board of Plastic Surgery; ideally one also who completed a The Aesthetic Society endorsed fellowship or is a member of The Aesthetic Society.

Thomas A. Mustoe, MD, FACS · Answer

Thank you for your question and for sharing your photos. This is a common concern, but one that can be remedied with a thoughtful approach.

The tip turning downward with smiling is usually caused by the depressor septi muscle, along with tip support and nasal length. The dorsal hump is a separate issue, but both can be addressed together.

This is a pattern that generally responds very well to rhinoplasty, allowing refinement of the bridge and improved tip support so the nose remains more stable when you smile. Your best next step is to arrange an in-person consultation with an experienced rhinoplasty specialist.

— Thomas Mustoe, MD, FACS

Erin Smith, MD · Answer

Hi, thanks for your question. A rhinoplasty would help to address the bump by shaving down the involved excess bone and cartilage. It would also help to address tip ptosis by resetting the tip into a more favorable position and targeting the depressor septi muscle, which pulls the tip down with smiling.

Alternatively, you could also inject Botox into the depressor septi muscle, which will help lessen any tip plunging that occurs with smiling. Of course, this would not address the other issues you mentioned.

Good luck!

Thomas Trevisani, MD · Answer

Based on your posted photos - your appear to be a good candidate for Rhinoplasty performed throuh a closed technique. In the right hands- you can expect significant improvement -provided that your expectations are realistic. I suggest that you seek a Board Certified PS who specializes in Rhinoplasty

Eric M. Joseph, MD · Answer

Based on your photos, you appear to have a wide, long, and crooked nasal appearance. This is associated with a droopy nasal tip appearance and a dorsal hump. Rhinoplasty surgery may be considered for achieving a straighter and narrower nasal appearance, with a tip lift, and hump removal, for a less distracting and more feminine nasal appearance. I hope this helps! Sincerely, Dr Joseph

Ahmet Altintas, MD · Answer

Rhinoplasty would help the results that you are looking for. Also for the smiling, lip filler would be much better when it combined with rhinoplasty surgery. You don't need to be scared, everything can be done.

Kadir Berat Oyur, MD · Answer

Thank you for your question. From your photos and description, it appears that your nasal tip droops when you smile, likely due to dynamic muscle activity, along with a mild dorsal hump.
You would be a suitable candidate for a rhinoplasty to refine the profile and provide better tip support, helping to prevent the nose from turning down when smiling and creating a more balanced appearance.
I hope this helps.

Mark Beaty, MD · Answer

It is not uncommon for the nasal tip to drop when smiling, and there are rhinoplasty techniques that can help—specifically addressing the depressor septi muscle, which is responsible for pulling the nasal tip downward during smiling. Adjusting this can create a more stable, lifted tip.

That said, if your main concern is limited tooth show, a lip lift may be a more direct solution. This procedure shortens the space between the nose and upper lip to enhance tooth show when smiling, with a well-concealed incision at the base of the nose. A consultation with a board-certified facial plastic surgeon can help determine the best approach for your goals.

Gary M. Horndeski, MD · Answer

You are an excellent candidate for a rhinoplasty. Your nasal columella angle is at 90 degrees and should be at 110 degrees. You have a dorsal hump and bony cartilage prominence from the frontal view. You would also benefit from from an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Nose turns down when I smile - Would a rhinoplasty help? (Photos)

Answers (19)

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