Questioner: Can I improve my smile through closed rhinoplasty but without reduction?
Hi. I'm relatively happy with the shape of my nose (and the tip) when not smiling. When I smile, my nose droops (curves down) and my nostrils "stretch" and get a bit longer/bigger. I know that the removal of the depressor septi + placing a graft, while rotating my tip up will improve my smile. I'll also be removing the nasal hump (all through closed rhino). Will this fix the curving down or do I have to get a reduction? Will my nose (front) look wider if I don't do reduction? Thanks!!
(Questioner submitted photos)

Dr. Denenberg's answer: Your surgical plan worries me
Hi,
I'll give you my take on your comments and photos.

In my experience, doing something to the depressor septi muscle does nothing, or almost nothing, to the nose, either at rest or during a smile. It's one of those things that seems to make sense mechanically when you look at the anatomy books, but it doesn't work in practice. When someone gets a good improvement in that area, it's because of *other* things that were done during surgery, not because of work on that minuscule muscle.

Next: placing a graft will not rotate your tip up, any more than taping a Q-tip stick to the underside of your nose will cause it to rotate up. Rotating the tip of the nose up requires advanced work on the tip cartilages, something most plastic surgeons are not successful at, so you need to see lots of before and after photos from the surgeon you are considering using, to see that he has successfully shortened noses like yours. Especially: when a hump is taken down, it makes the nose appear *longer*, even if the position of the tip hasn't changed, so shortening the nose is very important in your case.

When you smile, the tip of the nose will always try to drop. After surgery, if the nose was shortened, the tip will be starting from a higher position, so when it drops with a smile, it doesn't get as low as it did before surgery, so that would make you more comfortable with your smiling nose, but the nose will still lengthen with the smile. In general, we try to set the nose so it looks great not during the smile, but for the other 99 percent of the time. 

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