Is It Routine to Cut the Levator Labii Superioris Alaeque Nasi Muscle?

Question

My doctor compromised my levator labii superioris alaeque nasi muscle during rhinoplasty.Is this a routine procedure and if so can it be reversed? It has changed the looks as well as the dynamics of my face when I speak and chew.I have to contract my muscles of my nose(scrunch my nose as if I smell something bad)in order to make my my facial muscle to feel and move the way they used to.Espically when I eat or else my upper lip moves too far below & under my upper teeth and makes it hard to chew.

Grigoriy Mashkevich, MD · Answer

This muscle is typically not in the surgical field for rhinoplasty, open or closed. If your surgery is recent, surrounding muscle dysfunction can be related to nerve stretch and trauma, which should be reversible. It generally takes 6-18 months for nerve and muscle function to return in the face.

	I disagree with the other post that open rhinoplasty leads to more complications and deformities. My advice is to give it enough time to heal. You can consider doing facial physical therapy to hasten recovery.

	Good luck,

	Grigoriy Mashkevich, MD. New York Facial Plastic Surgeon.

James C. Marotta, MD · Answer

It would be quite unusual to cut the levator labii superioris alaeque nasi muscle during rhinoplasty surgery as these muscles are quite lateral (to the side) of the field of surgery. As a surgeon you would have to go out of your way to actually do that. You may be thinking of the depressor septi muscle which some of the fibers can be cut in nasal surgery which has no real bearing on the appearance or function of the nose except to raise the nasal tip slightly and prevent tip depression which is usually a desirable thing. I would discuss these points with your surgeon to get a better understanding of what is going on. Perceived changes in movement of the upper lip can occur for quite some time following rhinoplasty but are generally temporary in nature. Columellar struts, plumping grafts, or work on the nasal spine are more likely to cause these temporary symptoms but are generally necessary to achieve the aesthetic goals. The benefits in these cases far outweigh the costs.

John M. Hilinski, MD · Answer

As a rhinoplasty specialist in San Diego, I can tell you that I rarely perform this type of muscle work as part of cosmetic nose reshaping. This is primarily because I think it is unnecessary in most instances of rhinoplasty or revision rhinoplasty. I am also worried about what you are experiencing in terms of changing the dynamics of facial movement following this maneuver. As far as I know, this is not something that can be easily reversed, either.

Darryl J. Blinski, MD · Answer

It is very rare to incise this muscular area. I recommend to have in person second opinions to be sure you have had this issue.

Mark B. Constantian, MD, FACS (retired) · Answer

I have trouble picturing what deformity you are experiencing, but I believe that your diagnosis is wrong.  If you have distortion of your nasal base or nostrils or upper lip after rhinoplasty--especially open rhinoplasty--that is understandable and largely correctable.

	My recent review of 100 consecutive patients  treated open or closed in their first operation indicates that open patients have more numerous and more severe deformities than those patients who had been treated closed. The problem is not with the surgeons, but rather with the operation, which creates numerous chances to create new deformities.  Open rhinoplasty is an error-prone situation for many surgeons.  Any rhinoplasty has the possibility of postoperative imperfections.

	You also do not say how long you are after surgery or how this diagnosis was made.  You must also consider the possibility of other diagnoses, so find a good surgeon.

	If you need another operation, find an experienced surgeon who can show you corrections of the problem you are having in other patients, and good luck.

Is It Routine to Cut the Levator Labii Superioris Alaeque Nasi Muscle?

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