My smile is messed up after my rhino, nasal spine premax implant? (Photo)

doctors please help. i had a rhinoplasty where my columella and tip were projected and pulled down. i also had a premax graft placed through my upper lip area to give me more of a "push" to the area under my columnella, nasal spine area. my smile is completely messed up now and its been 1 year. as you can see my smile before was full, natural and my upper lip was thick, now when my smile it looks tense,frozen and strained and very messed up whats causing the problem?should i remove the premax

Doctor Answers 3

My smile is messed up after my rhino, nasal spine premax implant?

Rhinoplasty always has the potential to alter the shape of your smile temporarily or permanently. Certain features of your surgery, based upon your description, would place you at risk for that happening, such as columellar work, tip de-projection, and pre-maxillary graft/implant placement. Columellar work may disrupt the attachments of the depressor septi muscle, which elevates the upper lip with smiling. When you look at your "after" photo, you can see that the upper lip is inverted and does not "roll out" as it did before the surgery when you smile. Despite this, the lip also appears to be slightly pushed down, potentially from the implant; ideally, your surgeon would be able to palpate the implant/graft to ensure that it did not displace. Repairing your smile does not necessarily have to mean removing the nasal implant. If there is a scar band present, placement of some kenalog may be useful while adding some volume to the upper lip can help "roll it out" a bit although it will not improve the lip mobility during smiling. Finally, if none of those things help, be prepared to potentially have the implant removed, trimmed, or repositioned. Best of luck!


Clermont Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Stiff Upper Lip After Premaxillary Graft

Thank you for your question. Are the before and after photographs from the same person? It appears that the shape of the teeth, spacing of the teeth and dental occlusion are significantly different between the two photos?

Some premaxillary grafts can restrain upward movement of the upper lip upon smiling . In particular, larger implants add stiff volume to the area beneath the nose, which makes it harder for the upper lip (elevator) muscles to do their job. Scar tissue from the procedure can also contribute to stiffness of the lip early on.  With massage and the occasional steroid injection, the stiffness often resolves and most patients regain full movement over time. The decision to remove the implant would require that the advantage of removal (a small increase in tooth show) clearly outweigh the benefit of the implant on nasal projection and facial harmony.You should talk to your surgeon to make certain you understand all the implications of removing the implant before making a decision.  

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 99 reviews

Post-op smile

Sorry to hear that your smile has been changed in a way that is unfavorable to you. Placing graft material at the base of the columella, coupled with upper lip incisions and resultant scarring, could lower your upper lip or prevent it from moving upward on smiling. The loss of "vermilion show" or the amount of red lip showing could be from a slight rolling in of the mucosa or from a change in the dynamics of the tissue upon smiling. It is, indeed, a difficult problem to correct because a surgeon operates on what he can see at the time of surgery, not on what will happen with movement subsequently. However, knowing the probable reasons for this condition (as I mentioned above) would give a surgeon some idea of what might be done to reverse it. However, scarring, tissue contraction, etc still make achieving a total reversal somewhat unpredictable. Good luck! 

Stephen J. Pincus, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 2 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.