Smile Permanently Affected After Rhinoplasty??

Question

In my rhinoplasty 20 months ago, cartilage from my ear was added to the tip of my nose. My septum is hard when i touch it and my upper lip doesn't go all the way. When i smiled before the surgery my upper front teeth were revealed 100%, a month after-50%, and now 85% hasn't changed the last year. what can i do to make this piece of cartilage get a more soft texture and the lip to be "allowed" up again? My doctor is not willing to do anything about it, he is not a part of any future solution

Michael L. Schwartz, MD · Answer

If you started out with a droopy under projected tip which pointed down on smiling it's likely your doctor used a strong fixation technique to be certain the tip would not lose its projection and again droop when you smile. These techniques yield great results but will have a tradeoff of a more rigid less pliable tip for a long time. If you have achieved the tip position you wanted then be patient. It's likely that it will eventually be more pliable and you will see more smile but it may take 2 or 3 years. Ask yourself what would bother you more, your current smile or a tip that was still droopy and downward pointing on smiling?

Peter E. Johnson, MD · Answer

It is possible that the tip of the nose will stiffen, and the smile be affected by rhinoplasty. Your tip must have needed an incredible amount of support to maintain the shape if ear cartilage grafting was required. After two years, it is unlikely that things will change much. If you really like your nose and the airway is good, you should leave it alone.
	Best of luck,
	peterejohnsonmd

S. Randolph Waldman, MD · Answer

I am certain that the support cartilage of the nose ie the portion taken from your ear is responsible for the change in lip elevation when smiling. My experience is that the smile almost always returns to a pre-operative state, but it may take two years or more.

David A. Bray, Sr., MD · Answer

Stiffness in the tip is common. Tip grafts are newhere as popular as they ten years ago. You might try smiling exercises. I have neveer had this problem from tip work alone unless something was done to the nasal base. If this procedue was done open, scr tissue might be a problem.

Michael G. Brandt, MD · Answer

I can certainly appreciate your concern about the stiffness of your nose and the change to your smile.  Although it is impossible for me to make suggestions without examining you or seeing photos, I suspect the changes you describe may be permanent.  

	Cartilage grafts to the nasal tip can result in greater stiffness to the nose.  Additionally, modifications of the nasal base and septum can result in changes to your smile.  As a surgeon one strives to strike a balance between achieving an aesthetically acceptable outcome while maintaining a natural feel to the nose - sometimes  a compromise has to be reached one way or the other in order to deliver on a mutually agreed upon surgical goal.

	At this point I would encourage you to seek out a second opinion from an experienced rhinoplasty surgeon to determine if anything can be done to deliver on your expectations.  I would anticipate that the stiffness can be modified, but would likely result in an aesthetic change to your nasal tip.  Perhaps your smile could also be modified, but only a consultation can make this determination.

Richard W. Fleming, MD (retired) · Answer

The softness if your tip may never return after placement of cartilage grafts to improve your appearance. Unless something else was done to the base of your nose, your smile should  return to normal.

Francis R. Palmer, III, MD (retired) · Answer

Rhinoplasty can effect the smile, especially if the tissues at the base and just in front of the columella were dissected during the Rhinoplasty. This can cause some weakness to the upper lip. Stiffness, in the columella would be a very minor contributing factor at 20 months post Rhinoplasty, IMHO. I am not sure that's there's a quick, easy or reasonable solution. Is it possible for you to exercise (raise the upper lip in an exaggerated manner) the upper lip for several months and see if this helps?

Smile Permanently Affected After Rhinoplasty??

Answers (7)

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