My nose has really started to droop especially when I smile. What treatment would you recommend? (photos)

hi! My nose has really started to droop.. especially when i smile. I don't mind my nose when i'm relaxed, however when i smile i am really disappointed. Could someone please tell me what are my options/ is it possibly causing my smile to look weird?? Also i read about cutting the muscle depressor? Let me know. i added both side profile and front view pictures

Doctor Answers 8

Nose drooping

Dear Emilyxoxo,

Thank you for submitting your clinical photos. Your concern is a very common one. You have what appears to be a very attractive, long, lean face. You have beautiful teeth and a big, wide smile. When you smile, you have a very strong nasal bridge and you have what is called a tension tip. The tip, which is not as supported as it should be, tends to rotate due to the very short columellar labial angle, a strong depressor septi nasi muscle and a fulcrum point at the strong inferior aspect of your septum.

You really have several options, the first of which would be unacceptable and that is stop smiling. All joking aside, you have the right approach. You have the right approach in seeking an advanced facial plastic surgeon with experience in nose surgery and facial aesthetics. You can arrive at a non-surgical and a surgical option. I am a plastic surgeon who did training in head/neck/ ENT oncology and reduction rhinoplasty is one of the more common procedures I perform in my practice. However, you can start with a non-surgical technique, such as Botox® to the depressor septi nasi muscle and a soft tissue filler such as Juvéderm® or Voluma™ in the nasal tip and what is called the columellar, or partition between the two nostrils, would help support your tip on smile.

I have been doing this procedure, called the five-minute nose job, for over ten years and this approach will provide a definite improvement for your concerns and has the advantage of not being surgical and having very little risk. Injections into the nose come with the risk of soft tissue necrosis, but seeking the expert opinion of someone with a lot of experience can minimize that risk.

Of course, it does appear from your photos that you do have a dominant nasofacial contour and profile and a simple reduction rhinoplasty, performed to the specifications that you decide between you and your surgeon, should provide less of a tension tip and decrease the plunging. During this procedure, the nasal bridge is brought down, the nose is shortened slightly, there’s a slight rotation that occurs at the nasal tip – not to a Miss Piggy angle, but about from a 90° angle that you currently have to about 100°. A columellar strut or graft placed between the central partition helps support your tip, similar to how a tent pole in a Cub Scout tent would support a tent.

These types of very straightforward, non-surgical and surgical options should provide you with the kind of aesthetic improvement you’re looking for. I would seek the advice of experienced plastic surgeons and ear/nose/throat facial plastic surgeons where rhinoplasty is one of the major procedures performed in their practice for the non-surgical and surgical options.

For more information, please review the link below.

I hope this information has been of some assistance and best of luck.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

Toronto Plastic Surgeon
4.6 out of 5 stars 95 reviews

Drooping nose

The droop can be improved by treating the depressor septi muscles through the base of your nose or an incision on the inside of your upper lip--this latter approach would slightly lengthen your lip. You tip can be rotated slightly upwards as well.

Paul M. Parker, MD, FACS
Paramus Plastic Surgeon
5.0 out of 5 stars 35 reviews

Nasal tip droop with smiling

Most people's nose droops when they smile. It only becomes a problem when the droop is excessive or when the tip starts off under rotated.

Most people feel its the tip being pulled down by the depressor nasi muscle under the nose. This is true in some cases but in addition the cheek muscles also pull the sides of the nose up. This gives the appearance of the tip depressing. The depressor muscle can be cut, while the cheek muscle obviously can't.  

Rhinoplasty can strengthen the tip by adding struts of cartilage behind the columella (the fleshy part below the nose and between the nostrils). The tip can also be rotated up and thereby reducing the overall degree of tip descent.

Oakley Smith, MD, FRCSC
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 93 reviews

Droopy tip

Release of depressor muscle will solve your problen of droopy tip during smile.  Along with tip sharpening and little elevation of tip with columelar strut will make your  nose very good

Milan Doshi, MS, MCh
India Plastic Surgeon
4.8 out of 5 stars 154 reviews

My nose has really started to droop especially when I smile. What treatment would you recommend?

Agree with Dr Portuese post. Best to seek only in person opinions for full rhinoplasty and lip muscle release.... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Correction of Droopy Tip

 A droopy tip is the consequence of weak tip support whereby the overactive depressor septi nasi muscle pulls the tip down. Commonly the choice technique is augmentation of  the tip support with application of a graft that is called a columella strut. Insertion of this graft usually disrupts the continuity of the muscle in addition to increasing the tip support. Although this muscle can be also be removed. For those who do not wish to have surgery injection of small amount of Botox can stop this muscle. However, this injection may result in slight elongation of the upper lip and minor change in the smile and the amount tooth show during smiling.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 21 reviews

Rhinoplasty with release of the depressor septi ligament

Closed rhinoplasty techniques can refine the nasal  bridge and elevate the  tip of the nose. To prevent the tip from drooping when smiling, releasing the depressor septi ligament is required. For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Nasal tip droop with smiling


Thank you for your question and your photos. Tip depression, particularly when smiling is a very common complaint for patients that are undergoing rhinoplasty. You are correct that the depressor muscle can be divided during the procedure, but the most important component during rhinoplasty for patients that have tip depression is to create more support for the tip. The two techniques that we use are to either put a cartilage graft (a supporting strut in the tip), or to secure the soft tip cartilages to the strong border of the septum. This adds strength and support which will prevent the tip from pulling down.

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 131 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.