Can I fix a a tip that over-projects when smiling without rotating it upward? (Photos)

Question

When I smile, my nose tip extends far past my nostrils and my nose appears wider. I have noticed that if I engage the muscles around my nose when smiling, My nose doesn’t have the “witch-like” appearance from the front, however from the side, my tip appears to angle downwards in comparison to my resting face. While I prefer the front profile of the “engaged muscles”when I smile- it is not my ideal side profile. Many after pictures that I see for rhinoplasties push the tip upwards, and sharpen the nose. I am mostly satisfied with the angle/look of the tip when my face is at rest and do not think that pushing it upwards would give me the results that I am looking for. I am concerned with how that would change the exposure of my nostrils, and the lengthen the look of the lower third of my face. When using editing tools, I find that simply bringing the tip closer to my face and shaving the bridge, balance and feminize my side profile, and narrowing the tip a bit does the same for my front profile. I am wondering what techniques could be done to bring harmony to my face while also correcting the “witch” nose that appears when I smile.

Zoran Potparic, MD · Answer

You seem to be a candidate for rhinoplasty, a very conservative one. Only on the basis of in person consultation, an experienced board certified plastic surgeon, expert in rhinoplasty, could understand and address dynamics of your nose movement when smiling and propose adequate correction. Good luck.

Gary M. Horndeski, MD · Answer

Your nose on the side view has a slight prominence of the tip. You may benefit from a reduction of the tip slightly. Your main complaint is when you smile. You may want to consider Botox into your depressor to depress the septi muscle. This will only take a few units of Botox but will be temporary 3-6 months. If this is effective, you may be better off with Botox then surgery.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, correction of alar retraction , among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Elie Ramly, MD · Answer

Thank you for your detailed description and photos. What you’re noticing is a common dynamic issue rather than a static one. In some patients, smiling activates muscles that together pull the nasal tip downward and forward and elevate and widen the alar base, making the nose appear longer, wider, and downward-pointing - even if the tip position and rotation at rest are already satisfactory. This is different from simply having a low or under-rotated tip at rest.
Importantly, correcting this does not necessarily mean pushing the tip upward or creating a sharper, over-rotated look. In many cases, the goal is to improve tip support (this is key!) and control tip movement with animation, rather than increasing tip rotation at rest. Techniques include strengthening structural support (a septal extension graft for example is a wonderful technique for this), modifying how the tip responds to smiling (through an intraoperative maneuver targeting the depressor septi muscle), and just as importantly, ensuring overall proportion and harmony are maintained.
Deprojection (bringing the position of the tip of the nose closer to the face) + subtle bridge refinement and careful tip narrowing are absolutely achievable together and actually work together to create overall harmony. A far too common issue I see when new patients present for a revision rhinoplasty consultation is when one feature (a dorsal hump for example) has been modified but nothing was done to harmonize the profile accordingly (nasal tip deprojection is what's necessary in many such cases) - or the other way around: if the nasal tip is being deprojected, the dorsum actually needs to be subtly modified to be harmonious with the new profile.
Natural aesthetic harmony within the nose and between the face and nose is the goal, and this is definitely achievable when anatomical, structural, and functional principles are respected in an aesthetic procedure. The best way to determine the exact surgical maneuvers for you and what would be safely achievable for your anatomy is through an in-person evaluation by a plastic surgeon who specializes in rhinoplasty.

Can I fix a a tip that over-projects when smiling without rotating it upward? (Photos)

Answers (4)

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