Why does my nose look different when I smile? How much would it cost to fix this? (photo)

Question

I don’t mind my nose when I’m not smiling or doing a “soft smile” but when I smile and show my teeth I hate how my nose looks. I feel like it looks like a different nose. How can this be fixed and approximately how much does it cost to fix that?

Steven M. Denenberg, MD · Answer

Click on the "Learn more" link, just below my response, or go here:
FacialSurgery.com/RealSelf/RealSelf_lex3697.html
I made a computer morph of your nose, and an animation of the morph, to show the changes that are possible for your nose in truly expert hands. I used an image from a previous post of yours.Whenever anyone smiles, it makes the tip of the nose drop. So the nose looks longer, and thus more prominent. The bigger the smile, the more the nose drops. We can't change that the nose will drop with a smile, but if we elevate the tip of the nose with surgery, then the nose starts from a higher position, and with the smile, the nose won't get down as far as it did before surgery.Your nose is just a bit on the longish side (depending on your tastes) and the tip is a bit wide, which makes the nose look longer, so you would be a good candidate for having the nose made less prominent by elevating the tip, narrowing the tip, and bringing the entire nose back a bit closer to the face. Then, when the nose tries to get more prominent with a smile, it can't get as far as it could before.Any of that make sense?
See if you think the morph captured what you're looking for.
You should understand that the changes I demonstrated in the morph require advanced techniques, techniques that most plastic surgeons cannot handle.  Be sure to read the section in the "Learn more" link on how to stay out of trouble while searching for a rhinoplasty surgeon. Rhinoplasty is an exquisitely difficult operation to get right, and you should only have surgery if you are able to make yourself very confident in your surgeon's skills. Read that page very carefully. Most plastic surgeons are quite poor at this operation, and I believe my advice will go a long way toward keeping you safe. For most noses, it's better to not have surgery than to have inexpertly-performed surgery.
I'd love to hear what you think of the morph. Did it seem to address some of your main concerns? I could modify the morph to your taste if you wish.
Your nose is also a good example of why computer imaging is mandatory in rhinoplasty. You need to know exactly what the surgeon is planning to accomplish -- what features he thinks he can change, and by how much he thinks he can change them. When you see his goals, you'll know whether he has an eye for an attractive nose, and whether he shares your opinion of what constitutes an attractive nose. You'll also know whether the changes he proposes are enough to be meaningful to you, and whether he understands your wishes enough to address all of your priorities. How would you ever get that figured out without the morphs?! But remember, you're not hiring him for his skills with the computer. The doctor must then show you his before and after photos to prove that he can actually accomplish what he draws on the computer.
In your case in particular, you need to find a surgeon who understands all of the issues I mentioned, and how they fit together, and who can actually accomplish them in surgery. Finally, it's usually the three quarter views that show the width of the tip best. At the *very* bottom of the "Learn more" page is a link to instructions on taking and sending photos that are comprehensive and useful for an online consultation like this, in case you'd like a more complete evaluation.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  Your nasal lacks support, so it is drooping with smiling.   Based on your
photographs, you may benefit from a tip refining rhinoplasty. Your surgeon can
accomplish this by trimming, suturing, and reshaping the cartilage in your
lower nose. You may also benefit from a cephalic rotation of your tip to turn
up your tip slightly.   Cost varies based on geographic region and surgeon expertise.  Make
sure you specifically look at before and after pictures of real patients
who have had this surgery performed by your surgeon and not just a computer
animation system. The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Philip J. Miller, MD, FACS · Answer

I would recommend starting with a consultation with a board certified facial plastic surgeon that specializes in rhinoplasty surgery to discuss if rhinoplasty can address your concerns. 
I would recommend writing down the following questions before scheduling your consultation:
1. Are you unhappy with the tip of your nose? 
2. Do you feel that your nose is too wide? 
3. Do you want to make your nostrils smaller in appearance? 
4. Are you looking to decrease the general size of your nose?
I hope some of these questions will help you pinpoint what it is that you don't like about your nose.  Cost will vary due to various factors like anesthesia fees, facilities fees, etc. I wish you the best as you research your options when scheduling a rhinoplasty consultation.
Sincerely,
Philip J. Miller, MD, FACS Double Board Certified Facial Plastic Surgeon

Mehdi Sina, MD · Answer

Hi,There is a muscle that pulls the tip of the nose down when smiling (depressor septi). In cases like yours, the muscle is usually cut during surgery as a means of treatment. A possible non-surgical alternative is to have the muscle injected with botox. Best,Mehdi Sina, MD

Thomas Trevisani, MD · Answer

In person exam is needed. Based on the limited photos and the description of your concerns- you appear to be a good candidate for Rhinoplasty- preferably through a closed technique- without a scar across columella. I recommend that you seek an experienced Board Certified PS

Jonathan Kulbersh, MD · Answer

Your nose could be improved with rhinoplasty, which would give permanent improvements in symmetry and shape. You can bring the pictures that you think would be flattering to your face and these can be discussed. When you meet with a facial plastic surgeon, he or she will consider your nose in balance with your other features and can over the cost of the procedure. Hope this helps.

Donald B. Yoo, MD, FACS · Answer

The changes you describe could be achieved with rhinoplasty. If you want the best idea of what is possible for your nose, do your due diligence, find an experienced surgeon, and have him/her evaluate you in person and discuss your options. Looking at computer-morphed images with your surgeon during consultation will give you a good idea of what is possible, and also give you a great chance to convey to your surgeon what you envision.

Adam Hamawy, MD · Answer

There is a small muscle located below you're nose call the depressor nasi septi. In some people when they smile, this will pull down on the tip of the nose and change the appearance.  This can be corrected temporarily with Botox injections or surgically by releasing this muscle through a small incision inside the nose.  This maneuvers often performed when refining the tip during a rhinoplasty procedure.

Paul Tulley, MD, MBBS, FRCS(Plastic) · Answer

Many thanks for your question. From the pictures you’ve shown your nasal tip may well lack support, such that on smiling it tends to drop and the shape of the nose changes. This can be corrected by a number of techniques such as the placement of a columellar strut graft and tip sutures, and possibly further sutures between the alar cartilages and septum or upper lateral cartilages. The exact requirements would depend on detailed assessment in clinic by a plastic surgeon experienced in rhinoplasty.Good luck with your treatment.

William Portuese, MD · Answer

Some patients  nose droops when they smile which is caused by an active depressor septi ligament. This ligament can be released at the time of the rhinoplasty procedure. For many  before and after examples, please see the link and the video below

Why does my nose look different when I smile? How much would it cost to fix this? (photo)

Answers (10)