The tip of my nose turns down significantly when I smile, what are my options? (Photo)

Question

This is something that started happening within the last 5 years, and I'm not sure why. I understand that the downward turning could be a result of a hyperactive depressor muscle - so I guess my question is should I consider surgery or would Botox in the muscle be enough to fix my "beak" (as I like to call it). Also, what could have caused this to start happening?

N. Bill Aydin, MD · Answer

Botox is a temporary but effective way to eliminate the tip animation with smile. Your upper lip looks narrow and restricted. Therefore, with smiling it's pulling down on your tip. You can also address all these issues surgically with either a full rhinoplasty or just limited surgery to release the depressor muscle.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your
photograph, you may benefit from a cephalic rotation of your tip to turn up your tip
slightly and a conservative dorsal hump reduction.  The depressor muscle can also be addressed at this time to alleviate your tip droop with smile animantion. The most important aspect is
to find a surgeon you are comfortable with. With good surgical technique, you
could have an outstanding result. 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.
Harvard-trained plastic surgeon

William Portuese, MD · Answer

A closed rhinoplasty approach can accomplish shaving down the dorsal hump, lifting or droopy tip,a nd her finding the bridge line, with all of the incisions placed on the inside of the nose.  When patients have a droopy tip when smiling, it's important to release the depressor septi ligament which pulls the tip down with animation. For more information and many examples, please see the link and the video below

Benjamin C. Paul, MD · Answer

Thanks so much for your question.If your tip droops when you smile, then either the cartilaginous support of the tip is being depressed by a muscle between the nostrils called the depressor septi, or the cheeks are rising leading to an illusion of tip droop.  It is safe to put a small ammount of botox into the depressor muscle, and see if relaxing the muscle solves the problem. Lastly, the tip can be supported in rhinoplasty which is a maintenance free, long-term solution.Best of luck,Dr. P

Steven Wallach, MD · Answer

Smiling can pull on the tip a bit and also widen the nose.  You can try botox as a temporary correction to soften the look.  Recent studies suggest that the tip plunge is more of an illusion as the other structures around it move.

The tip of my nose turns down significantly when I smile, what are my options? (Photo)

Answers (5)

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