Why Can't I Smile After Rhinoplasty?

Patients may note that their smile has slightly changed in the postoperative period following rhinoplasty for about 3 months.  Depending upon the technique used this may be due to splinting or muscle soreness, stiffness or rigidity of the operated nasal tissue, or the fact that the upper lip is more visible following tip elevation.   Given more time, the tip softens, the soreness abates, and your smile will return to your baseline. 

After 9 weeks, you will still be experiencing swelling. This may cause some difficulty when trying to smile. In general, 70% of the swelling is resolved after 3 months, and the remainder goes down over time. The swelling can be influenced by the thickness of the patient's skin, whether tip work was performed, whether the procedure was open or closed, and whether or not the procedure was a revision. It is difficult to give you precise advice without performing an exam and knowing more about your procedure, but the condition should improve over time. I would recommend following up with your surgeon, as they know the details of your procedure and exactly what was performed. I hope this helps, and I wish you the best of luck with the remainder of your recovery.

     If your tip drooped especially during smiling, the muscle have been released.  You should ask your surgeon what was done specifically and advice on what to expect.  Kenneth Hughes, MD Los Angeles, CA

In general, almost all noses are numb right after a rhinoplasty. In most cases its the tip that is numb, but this numbness can extend down to the upper lip, and in rare cases some of the teeth. There are nerves that are cut and stretched during a rhinoplasty, and it takes a long time for those nerves to start working again. This is true of an open as well as closed rhinoplasty, although it tends to be more extensive in open rhinoplasty. This could also be more extensive if a septoplasty is performed at the same time. A revision rhinoplasty is a much harder surgery with a lot of internal scarring to cut through. This can also be a reason for prolonged numbness. This, along with the swelling, gives you a stiff, plastic type feel, and can give you an odd smile. However, the nerves will start working and again, and your nose stiffness will go away with time. As the nerves grow back, you may feel some tingling, itchiness and on occasion pain. This takes in most cases months, but can take years in rare cases. Extremely rarely, the numbness is permanent, although I have never seen such as case.Best Wishes,Pablo Prichard, MD

Your surgeon may have resected or cut out your septal depressor muscle in the upper lip. It frequently is the cause of the nasal tip being pulled down when a person smiles. It is many times an integral part of rhinoplasty surgery. The stiffness and numbness gets better with time.

At nine weeks after surgery your nose as you say is very swollen and therefore stiff. This will impact your smile until the swelling subsides more.

Several factors come to mind from your question.  It is possible that you are still swollen and stiff and need more time for your soft tissue to get back to normal.  It is possible that the nasal tip has been overly rotated and has caused some foreshortening of your upper lip.  The numbness will improve over time.  Your plastic surgeon is in the best position to know where or if you have a problem that requires correction.

After rhinoplasty, it is common to have swelling, numbness and stiffness at the base of the nose for 3 or more months. Discuss your concerns with your surgeon as he can best advise you about this temporary condition, or rectify it if it does not improve in 6 to 12 months.

Not being able to smile after a Rhinoplasty is very common and this may continue for about 3-4 months.  It occurs because of swelling in the muscles of the upper lip.  As that swelling subsides the smile should return.  If it persists after 4 months you should consult with your surgeon.