My Surgeon Cut the Depressor Septi Muscle to Stop my Nose Drooping when I Smile but There's Little Improvement. What Can I Do?

Question

Hi, My nose tip droops when I smile and the bridge becomes more curved like a 'roman nose'. The surgeon only cut the depressor septi muscle and interestingly the bridge of my nose is straighter when I am not smiling, however there is little improvement in the drooping of the tip when I am smiling. Is it possible the surgeon cut the wrong muscle? Is there anything I can do? Thank you so much in advance

Philip J. Miller, MD, FACS · Answer

Either the muscle needs to be cut further or the tip cartilage is weak and can not withstand the external forces associated with smiling and droops. To determine if there is still muscle action present, a small amount of Botox can be injected at base of the nose, where the columella and the lip merge. If you still have tip droop after that, then the cartilages may be too weak and they need to be reinforced. If the droop goes away, then the muscles need to be released further.

Babak Azizzadeh, MD · Answer

You likely need tip reconstruction with structural support to prevent the dropping.  I would suggest going back to your surgeon to discuss or getting a 2nd opinion.

Steven Wallach, MD · Answer

Tip droop can happen from either the muscle being very strong or poor tip support. I do not commonly divide the muscles, but do reinforce the tip. This usually eliminates the droop.

Joseph Campanelli, MD · Answer

If you are still experiencing tip droop when you smile, the muscle was not completely transected.  Fortunately, this can be done quite easily in the clinic under local anesthesia.

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

My Surgeon Cut the Depressor Septi Muscle to Stop my Nose Drooping when I Smile but There's Little Improvement. What Can I Do? That's not a substitute for rotating the nasal tip upward which is what would be required. I have done this through an isolated incision along the anterior nasal septum with placement of a permanent suture to rotate the nasal tip upward and elininate the tip droop.

Talmage J. Raine, MD, FACS (retired) · Answer

The drooping of the tip when smiling is dynamic and due to the depressor muscle.  However, it sounds to me like you would benefit from an actual rhinoplasty with elevation and refinement of the tip as well as surgically altering the dorsum.  This suggestion is tempered by the fact that you did not provide any pictures.

	All the best,

	Talmage J. Raine MD FACS

My Surgeon Cut the Depressor Septi Muscle to Stop my Nose Drooping when I Smile but There's Little Improvement. What Can I Do?

Answers (6)