It is very important that the cosmetic nasal surgeon understand what makes the nose unsatisfactory. The patient in the photo has a very active depressor septi muscle which, as part of the muscles of facial expression, when employed, exerts a downward force on the nose. The profound drop of the tip of the nose with smiling, detracts from the smile itself.
The smile that tugs the nose downward makes the profile even less satisfactory. This is why it is very important that this be managed during the cosmetic nasal plastic surgery. It is not a complicated maneuver for the surgeon to perform. Through a hidden incision inside the nose, the surgeon works behind the lip to detach the muscle from its internal attachment to the nose. Then, the muscle no longer can tug on the nose during smile.
The constant smile-driven, downward pull upon the nose also has implications for aging. As we get older, the tip of the nose tends to droop naturally because of the effect of gravity, and the stretching and loosening of the connective tissue within the nose. So there is a case to be made for releasing that depressor muscle at rhinoplasty. Not only because it helps the smile but because it will slow the “aging” of the nose.
- Robert Kotler, MD, FACS