Smile Permanently Affected After Rhinoplasty??

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

Doctor Answers 8

Smile change

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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?

West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Improvement Will Continue to Occur

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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.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Rhinoplasty is about balance.

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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. 

Michael G. Brandt, MD
Toronto Facial Plastic Surgeon

Smile Permanently Affected After Rhinoplasty??

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There are different kinds of rhinoplasty operations however we can divide them as the one that requires bone excision and the one that does not need bone excision. The main fact that we classify the rhinoplasty operations like that is that the results and postoperative period is associated closely with this fact. In the operations like “nasal tip correction”, “simple rhinoplasty” there is no need for a bone excision however these minor operations cannot be beneficial for everyone. The operation type is need to be determined by the surgeon according to needs of the patient. In these minor operations the rhinoplasty is performed with closed method. The bone and the cartilage tissues are not involved in the surgery directly. Small nasal bumps can be removed in these operations.

In the operation that needs the bone and cartilage tissues to be involved; open approach is used. In the procedures with open approach, the size, shape and functionality of the nose can be improved. The big nasal bumps can be removed and septal deviations can be corrected providing a better nasal airway.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.8 out of 5 stars 102 reviews

Change in Tip Softness and Smile after Rhinoplasty

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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.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Reduced smile after rhinoplasty

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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.

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

Smile affected by Rhinoplasty

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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?

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Smile has changed after rhinoplasty

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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,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.