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Steven M. Denenberg, M.D.
Dr. Denenberg's articles on Medium.com.
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Views of this rhinoplasty patient:

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In the before picture, you can see some white marks in the middle of her dorsum that are reflections from the flash, right where the hump was.  The marks are crooked, indicating that her nose was a little crooked in that area before surgery.  I mentioned in the section on nasal reconstruction that correcting a crooked nose is one of the hardest changes to make in rhinoplasty.  However, if the crooked area is small, and if it's on the hump, sometimes simply removing the hump removes the crookedness entirely.

We also know that her nose was shortened somewhat during her rhinoplasty, because we get a better view of her nostrils in the after picture.


next view of this patient

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All views of this rhinoplasty patient:
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current: Frontal
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Next: an example of the solid advice Dr. Denenberg gives patients on RealSelf.com.
Get that advice for your own situation by emailing your photos to Dr. Denenberg.

Questioner: My nose is too narrow and I have droopy tip when smiling after rhinoplasty. Is this because of my smile muscle?
I had a septorhinoplasty done almost 2 years ago by a well certified doctor. The procedure was to correct my septum, straighten my nose, hump reduction and reduce a bulbous tip. Overall I feel my nose looks better but it seems that the tip is too narrow looking pointy and the tip droops when I smile. I feel this has gotten worse over time. My surgeon says its because of my smile muscle, is that true? Is this something a tip revision can correct?
(Questioner submitted photos)

Dr. Denenberg's answer: A contrarian viewpoint
Well, you didn't post any **non-smiling** views, but from the smiling view you submitted it seems to me that your nose is long, even without smiling. Everybody's nose tries to lengthen when smiling, but it doesn't lengthen *hugely*, and in order for the nose to not look too long when smiling, it needs to be shorter when the face is at rest. Perhaps if you posted profile views when not smiling, we would be better able to get this figured out.

I personally feel that it's just not possible that clipping a tiny muscle will fix this problem. In fact, it wouldn't fix anything at all. In another fact, I never clip that muscle, because I don't think it does anything. If we want a nose that is short enough, when smiling and when not, it takes advanced work on the tip cartilages, to get the tip to a good position, and sutures to hold the tip in place when the facial muscles try to pull it down with smiling.

Link to this question on RealSelf.com