Smile Affected by Rhinoplasty

I had Rhinoplasty three months ago which involved a Weir excision. The doctor placed permanent sutures in to prevent my nostrils from flaring. My smile has never been the same and my surgeon refues to answer my questions. I am unable to smile widely and when I do, it takes a great effort and looks forced. The skin around my nose is also tight and I feel a tightness in on the inside of the nostrils at the base. Can my smile be fixed, to make my upper lip look normal?

Doctor Answers 6

Rhinoplasty recovery

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Have read the other surgeons answers and agree that time is important. Massage the area where your incision was made to try and release the scar tissue. Massage hard enough that it's a bit sore or you'll be doing little good. Find out if he cut your tip depressors, this can at times lengthen the upper lip slightly. Not sure why he would need a permanent stitch for a Weir; I've been doing nothing but facial aesthetic surgery since 1988 and have never used a permanent stitch for a Weir excision. Hard to say if removing this stitch would help and I certainly would not do so without waiting 3-6 months. Should you see no improvement by then, seek the opinion of 2-3 experienced rhinoplasty surgeons.



Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 51 reviews

Rhinoplasty Recovery

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In the first several months following rhinoplasty, it is very common for both the nose - as well as the upper lip - to feel stiff. This can affect the appearance of the smile and is often frustrating for the patient. Usually, as the swelling subsides, the smile returns to normal and the smile feels and looks more natural. This can take months, so be patient.

If the appearance of your smile and the tightness does not improve over the next several months, it may be possible that your surgeon placed a "alar base cinching suture" with is a permanent stitch that is buried beneath the skin and pulls the nostril base together. I recommend you discuss your concerns with your surgeon. If you feel that your questions are not answered to your satisfaction, then seek the opinion of an experienced rhinoplasty specialist.

Rhinoplasty and smile

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Tightness after rhinoplasty may take 6 months or more to subside. This can be due to scar tissue and swelling  Give it some time it is likely to get better.. 

Give it at least 3 more months.

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 This may resolve itself in 3-6 more months. If after that time it has not, seek a second opinion from an experienced rhinoplasty surgeon in your area.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Difficult smile after Rhinoplasty.

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I'm sorry you're having dissatisfaction after your rhinoplasty.

If your nostrils were very wide, and you underwent Weir excision of the nostril skin, some tightness after 3 months may be expected. I don't personally perform Weir excisions because of the visible scar, but that doesn't seem to be the problem in your case. During my fellowship in facial plastic surgery over 10 yrs. ago, we occasionally placed permanent "cinching sutures" to narrow the nostrils. Your operative report would be helpful in determining exactally what was performed.

If your doctor won't answer your questions to your satisfaction, then get a second opinion from a board-certified facial plastic surgeon experienced in Rhinoplasty.

Feel free to post / email me a full facial frontal photo (smiling and in repose), and I'll be happy to give you my thoughts.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 429 reviews

You probably need to have the sutures removed.

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It's very hard to tell what the problem is without examining you, but my hunch is that the nostril sutures will have to come out. Wait at least another 3 months before considering a revision.

If your surgeon really refuses to answer your questions (which is hard to believe), then you need another doctor.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.