Why can’t I smile 6 months post-op? (photos)

What you are noticing is very typical of columellar struts. I have removed many in patients like you and it solves the problem

Hello! Thank you for your question.As far as I can see from your photos your swelling is almost gone so you can have your revision surgery whenever you want. In the photos you provided seems like you have hanging columella and it might be the reason why the smiling is not same it used to be. It would be more convenient to decide with face-to-face consultation. Best Regards!

Sometimes people's upper lip, in the center, can become very heavy after rhinoplasty surgery. I occasionally this heaviness persists for longer than 6 months. We have seen people experience Difficulty with smiling for many months after rhinoplasty, however, it has resolved in all of our patients to date. Please consider bringing up your concerns with your rhinoplasty specialist, and it might be helpful for you to look at your before and after smiling photos to see the true extent of change. I hope this is helpful! Sincerely, Dr Joseph

By your description, you likely had a caudal septal extension graft placed that can certainly impact smiling. It is indeed unlikely at this point due to the depressor septi muscle. If this is something that bothers you, discuss your options with your surgeon. Nothing went wrong with your surgery and placement of a septal extension graft is critical for nasal tip support and long-term results. A minor revision MIGHT be an option but your surgeon will know best.

Thomas Walker, MD, FACS
470-900-3223
@drthomaswalker

Your smile: after rhinoplasty even if septal work was not done and even if a Columella strut was not placed there is some stiffness of the upper lip which usually last several months. With septal work there is additional surgery at the base of the nose where the muscles connecting the tip of the nose to the lip are. with placement of columella struts there is also surgery in the area of attachment of the muscle connecting the lip to the tip of the nose. Even without deliberately cutting this muscle, called the depressor septi nasi, there is stiffness and some reduced teeth and gums show with a smile for several months after surgery. This usually comes back to normal after several months. If the depressor muscle is deliberately cut, And is cut thoroughly, meeting a segment was removed, the combination of cutting the muscle, doing septal work, and putting a columela graft, can all contribute to more dramatic stiffness and more prolonged stiffness of the upper lip. If the muscle was thoroughly cut there may be some small permanent change. Based on the photos you show it looks like there is only a millimeter or two reduction of teeth and gum show at the six month mark. This may improve further over the next several months, but there could be a very minor reduction of lip mobility on smiling that persists.