Rhinoplasty and Smiling

i really hate how my nose changes upon smiling *droops*. i have had something called a "sinch suture" so my nose doesnt droop when smiling. however i had it removed as i thought it affected my teeth show. however i kinda do want it back. i guess what i would like to know is what options are there so the nose doesnt move when smiling. i hate how from profile view how it looks when i do smile. is the procedure i had the only way or what other things can i bring up with my surgeon. thankyou

Doctor Answers 7

Drooping tip

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This not an uncommon issue. Usually I cut the upper lip muscles slighly and most importantly, I support the tip with a cartilage intercrural graft. Cinching sutures have been used to narrow the nasal base but, often lead to asymetry and discomfort.

Los Angeles Facial Plastic Surgeon

Tip movement with smiling indicates poor tip cartilage strength

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When your tip pulls down, it is not because of your upper lip or lip muscles; that's why the lip surgery didn't work.

The pulling down  is because your nasal tip cartilages aren't strong enough to hold your tip up and resist the pull.  This is called "inadequate tip projection" and is very correctable. 

Find an experienced surgeon whom you like and see how he or she an help support your tip better--my preference (because they are anatomical) is tip grafts.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Plunging Tip

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By the sounds of it, you have a plunging tip.  You had this addresses and want it back.  There are a number of surgical maneuvers which can be done to address this issue either by way of muscle cutting technique, implant or grafts.

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 30 reviews


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Nose droop on smiling is a common problem when the tip is ptotic and underprojected. It can also occur when there is "tension' in the nose because the nasal septum is pushing it down. rhinoplasty can correct this for you permanently.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Tip droop with smiling

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this problem is mainly a result of poor tip support - you would likely benefit from structural grafting of the columella and tip

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Nose droops when smiling, what's the solution

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 Photos are always helpful but from what you describe the nasal muscles overcome the inherent strength and support of the nasal tip, when you smile, causing the tip to droop.  The cartilage at the upper, anterior end of the nasal septum can be trimmed and an orthopedic permanent suture placed to rotate the tip and add strength to resisit the muscles effects. 

 This is a fairly common procedure, have done this many times and can be done with or without Rhinoplasty depending on what else is done to the nose at the same time.  By itself it's a 15 minute procedure with incisions in the inside of the columella.

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

Nasal appearance while smiling

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In some patients, the attachment of the nasal muscles in the central portion of the nose can pull the nose down while smiling. The easiest way to correct that is to snip that muscle during a rhinoplasty procedure and place a graft to prevent it from reattaching and support the tip of the nose. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 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.