Rhinoplasty to remove Depressor septi nasi muscle? Is this advisable?

It's hard to say what would be the best treatment in your case without seeing your nose, but it does sound like you have a plunging tip with smiling. I don't normally remove the depressor sept nasi muscle in these situations, but it may be helpful to release it in your case. I also often do other maneuvers to better stabilize the tip in these situations and it makes the nasal tip less mobile with smiling. If there is baseline tip drooping in addition to the plunging with smiling the tip can also be elevated somewhat to bring it into a better starting position.You can read about drooping tip repair at my web reference link below.

Dear RaboustaniIn general, all the interventions you mentioned are reasonable. It is always a matter of how much dorsal hump to remove and to what contour. How much is a little to you vs your doc. I would look at the surgeons before and after photos and see if in general they are consistent and he/she does a particular look. In contrast, is each rhinoplasty tailored to the face. Also, make sure you feel you and your doc have a clear understanding of what results you want.Digital pre/post pics of your own nose are a great way to communicate.Credentials and experience are important. They speak of dedication and discipline which will translate into consistent and reliable results. Always get more than one opinion.For a rhinoplasty, a board certified Plastic or facial Plastic surgeon should be a minimum requirement.

Without seeing your photos, it is difficult to agree or disagree with some of the recommendations made by your surgeon. However, many patients dislike the appearance of their nose and how the tip drops down with smiling. This can definitely be improved by addressing the depressor septi muscle. Your nose should look natural, but while it heals and as swelling resolves, it may feel uncomfortable to smile. However, as it heals and the swelling resolves, your smiles feel normal and most patients are excited that their nose does not come down with smiling. Best of luck to you!

Thanks for question.  What you are describing is a plunging tip.  To correct this, support must be provided to the nose so it stays up with smilng.  This is generally done with things like a columellar strut and possibly permanent internal nasal stitches.    Release of the depressor septi nasi muscle will also help since this muscle contributes to the plunge.  This should not change your smile and it is something I regularly do. 

The plunging tip is not what it appears.  If this were just a result of a depressor muscle then neurotoxin should be able to correct this and surgery would not be necessary.  However, it has been shown that it is the elevation of the base of the nostrils that makes the tip appear plunging.  A well constructed rhinoplasty should make all of this less apparent

The proposed procedures are all reasonable in the appropriate patient depending on individual anatomy and desired outcome.Following the advice from a surgeon
on this or any other website who proposes to tell you exactly what to do without seeing dimensional photos and more importantly without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of the operative procedure would not be in your best
interest. I would suggest you find a plastic surgeon with extensive nasal
surgery experience who is certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) or a facial plastic surgeon (otolaryngologist) that you trust and are comfortable with.
You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

The depressor septi ligament is responsible for pulling the tip down with animation and smiling.  We have released the  depressor septi ligament many times in our practice.  A simple releasing of the depressor septi ligament can be performed as a stand-alone procedure, or as part of rhinoplasty procedure. During the  rhinoplasty, the hump can also be shaved down and osteotomies will most likely be required after the hump removal. The tip of the nose  can also be lifted slightly, if needed. For many examples and more information, please see the link and the video  below