Where to inject botox to stop the nose from pointing down when smiling?

Question

I have always had an issue with my nose. It points down a lot when I smile, and so last year I had botox injected right under the columella and then 2 on either side of the nostrils. A few days later I looked so awkward smiling it was embarrassing. I looked as if I was really struggling to smile. However, it did stop my nose from moving. I would like to ask if that was the correct way to do it or if there is another way that I can achieve a non-moving nose and still keep my smile? Thank you :)

Andrei Metelitsa, MD, FRCPC, FAAD · Answer

You ask a great question! Very experienced physicians can inject a small dose of botox to relax an overactive nasal muscle (depressor septi nasi muscle)that is often exacerbated with smiling creating a drooping appearance. This is considered to be an advanced technique that requires great knowledge of anatomic landmarks of the face to ensure that you get a perfect result.

Alexandra Chambers, MD, PhD · Answer

Thank you for your question.It is normally enough to give a single dose of Botulinum toxin to the base of columella to reduce downwards movement of the tip.Surgical lengthening of the upper lip will also help for the problem.

E. John Serrao, MD (retired) · Answer

Thank you for your question.  This is an advanced technique and must be performed by an experienced injector to receive the desired outcome.  You should have an improvement in your appearance when injected properly.  Good luck!Best Regards,Dr. John Serrao

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