Rhinoplasty to Imrove Droopy Tip but Have Concerns How Tip Rotation Will Look on my Face (photo)

Hi, My nose droops significantly when I smile and also loses it's shape. I want to fix that as well as refine the tip and slightly rotate it up as I get older it looks longer. However, I have a long face and I am afraid that it will look worse from the front if the tip rotation shortens the nose. Do you think a small tip rotation and tip narrowing can be achieved without optical shortening the nose? Any advice on how exactly the shape can be improved?

Doctor Answers 18

Rhinoplasty to improve droopy nose tip

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The drooping of the tip upon animation occurs because of the depressor septi ligament.  This ligament is released at the time of surgery to prevent the nose from drooping down upon smiling.  Nasal tip refinement can be incurred through multiple different techniques including removal of a small amount of cartilage from the nasal tip as well as tip suturing techniques to narrow and refine the nose.  There usually is a slight upward rotation to the tip at this time upon performing these techniques.  Small osteotomies can also be performed to narrow the bridge, which will help reduce the widening effect when the patient smiles.  This can all be done through closed rhinoplasty techniques, under general anesthesia.  Look for a surgeon who has performed many surgeries such as your own so that you feel confident in what your expected goals will be.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Tip Drooping can be an illusion

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Sometimes the tip looks like it is drooping, but in fact, it only appears so.  The position of the tip is  related to the "alae" which is the piece of skin that forms the outside of the nostril.  Sometimes the point where the  alae meets the facial skin is what rises when you smile and gives an illusion that the tip is falling!   So, it is important to get the right assessment as to what is occurring in you before any recommendations are made. 

Philip J. Miller, MD, FACS
New York Facial Plastic Surgeon
4.7 out of 5 stars 100 reviews

It can be done

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Nasal surgery has become very refined in the current day.  The subtle tip rotation and refinement that you seek can be performed without changing the length of your nose.  The droopiness with smiling can be addressed by cutting or removing a small muscle at the base of the nose that causes this phenomenon.  Also, from the photos it does not appear that you have a long face.  Consultation with a board certified plastic surgeon will better define your goals, needs and an operative plan.  Good luck!

Modifying a droopy nasal tip with rhinoplasty surgery can be tricky.

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It is very difficult to give you advice with these photos, however it is clear that your muscles that pull your tip down are extremely active when you smile. This step to surgically interrupt these muscles is just one step in the procedure that will need to be discussed when you have your in depth consultation for rhinoplasty surgery. Good Luck

Laurie A. Casas, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 110 reviews

Shortening your nose

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Although your photos give limited information about the appearance elf your nose, it doe appear that some raising of the tip would be beneficial.  There are a number of surgical techniques used to accomplish this but it is generally pretty straight forward. You should consult a plastic surgeon with extensive experience with rhinoplasty to get their input and advice.  Good luck.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 31 reviews

Rhinoplasty and Tip Rotation

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Your nose is best evaluated when you are not animated. Having said that , a muscle at the base of your nose can be cut to decrease the drooping of your tip when you smile. Your tip can be narrowed and defined while increasing tip projection. While slight tip rotation is appropriate, it also appears that you have a hanging columella which contributes to that droopy tip look. Rhinoplasty surgery is a combination of multiple subtle maneuvers.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Rhinoplasty to Improve Droopy Tip-How will Tip Rotation Look on My Face

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It appears from this photograph that your head is slightly tilted to the right in the photograph in repose.  When your face is animated you have an over active muscle that isdefinitely pulling the nasal tip down.

You would benefit from nasal cartilage refinement, but it must not be overdone. It appears your skin is thick and if too much cartilage is removed you may experience alar valve collapse and have difficulty breathing after surgery.  Your nose should not be shortened.  The muscle that is pulling your nose down with smiling should be released

Good luck!

Rondi Kathleen Walker, M.D.

Rondi Kathleen Walker, MD
Washington Facial Plastic Surgeon


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Your photos show your nasal tip is rotate clockwise on the front view and the tip gets pulled in towards the plane of the face on smiling. These limited photos do not allow full assessment and the rotation on frontal view may even be due to your turning your head slightly in the photo. Trimming the tip cartilage alone usually gives one a mild few degrees of upward tip rotation and tip narrowing. The upperward rotation is usually so mild that it does not appreciably shorten the nose. The distortion with smiling may be amenable to cutting the muscle between the upper lip and the nose and suturing the tip cartilages to the septal cartilage.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Rhinoplasty to Imrove Droopy Tip but Have Concerns How Tip Rotation Will Look on my Face

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 I have performed Rhinoplasty for over 20 years and there are degrees to which the tip can be rotated upwards.  The nasal tip can be thinned and rotated slightly into a more aesthetic position, IMHO.  The problems that I have always had with computer inaging are as follows:

  1. The computer manipulates the tissues in a manner not achievable during the Rhinoplasty and as such is misleading at best.
  2. Anyone that can run the software can get a good result on the computer but clearly would not be capable of replicating that result in the OR with Rhinoplasty.

Always see real examples of before and after photos during consultation for Rhinoplasty or any plastic and cosmetic surgery procedures, not a compuiter generated image enhancement.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Computer imaging is a great way to show how your nose could look after surgery

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Patients are sometimes afraid to have rhinoplasty, fearing that changing their nose will alter their face or might not look good on their face. An experienced rhinoplasty surgeon can disuss all these possibilites as well as what might work with the way you look, also taking into account your ethnic identity.

I really like computer imaging for these reasons. Imaging helps the discussion about goals and how rhinoplasty can improve your nose but still not make you look too different from "yourself."

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 141 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.