Does rhinoplasty change your smile?

How the nose takes part in a smile

The nose moves when you smile because a small muscle ties it to the upper lip. The depressor septi nasi starts on the bone above the upper front teeth and attaches to the movable lower edge of the septum, at the base of the columella, the strip of skin between the nostrils. Its deeper fibres blend with the orbicularis oris, the ring of muscle around the mouth.

When it contracts, it pulls the tip of the nose down and shortens the upper lip. An anatomy review published in 2023 puts it simply: "This muscle also shortens the upper lip during smiling."

The muscle is not the same in everyone. A study published in 2000 dissected 55 cadavers. The muscle ran fully into the lip muscle in 62 per cent, partly into bone and partly into the lip in 22 per cent, and was absent or only rudimentary in 16 per cent. That is one reason two noses that look alike at rest can behave differently in a smile.

A second muscle nearby, the levator labii superioris alaeque nasi, lifts the upper lip and flares the nostrils. It is part of why some noses look wider when smiling. Width at rest is covered on the wide nose page.

Three ways rhinoplasty can change a smile

Each of the three has a different cause and a different time course, so it helps to know which one you are looking at.

Only the first is a side effect that wears off. The second and third are changes to how the face moves and looks, which is why they are worth raising before surgery rather than discovering afterwards.

A stiff smile in the first weeks

A smile that feels stiff, or an upper lip that does not lift as far as it did, is common early on, and it is usually swelling. Swelling collects around the base of the nose and the columella, next to the muscles that lift the lip.

Clinic pages put a number on how long this lasts, and the numbers do not agree: a week or two on one, up to two weeks on another, two to six months on a third. None cites a source, and we have not found a published study that measured it.

What has been measured is the swelling of the nose itself. In a 3D photographic study of 40 patients, about two thirds of the swelling present at the first check-up had gone by one month, and 95 per cent by six months. The post on how long the swelling actually lasts sets out what those figures do and do not show. They describe the nose, not the lip, and the clock starts at the first visit, not on the day of surgery.

People who post their own photographs online mostly ask one thing: is this permanent? Two points help. A still photograph records one expression, and in the early weeks it mostly records swelling. And a smile that still looks different once the swelling has settled is a reason to go back to the surgeon who operated, rather than to keep waiting. The post on what people mean when they say a nose job went wrong covers how to tell an unfinished result from a real problem.

When the tip drops on smiling: what surgery does with the muscle

A tip that drops on smiling has two parts: the support holding the tip up, and the muscle pulling it down. Support, and the angles used to measure the tip, are on the droopy tip page. This section is about the muscle.

Three approaches have been published, and none rests on a large study.

• Moving the muscle. In the 2000 study, the muscle was dissected and moved rather than cut in 62 patients with an overactive muscle, operated on between 1995 and 1999. The authors reported that the imbalance between tip and lip improved or was corrected in 88 per cent.
• Cutting the muscle. A 2014 study looked at 36 patients whose muscle was cut during rhinoplasty. On average the resting upper lip was 1.74 per cent shorter afterwards. It got shorter in 24 patients and longer in 12, and nothing predicted which. The authors describe the effect as small but unpredictable. They measured the lip at rest, not in a smile.
• Adding support. A 2021 study compared 29 patients whose muscle was released with 11 who also had a columellar strut, a small cartilage graft placed between the nostrils to hold the tip. After surgery, the tip dropped by 3.66 degrees on smiling in the first group and 2.27 degrees in the second. The difference was not statistically significant, and no measurements from before surgery were reported.

All three studies looked back at patients already treated, and two come from a single surgeon or team. They show the muscle can be addressed. They do not show how reliably.

How the tip itself is reshaped is on the tip plasty page.

Botox for a tip that drops when smiling

Botulinum toxin, often called Botox after one brand, can weaken the muscle for a few months without surgery. It does not change cartilage or bone, so it cannot change the shape of the tip at rest.

The 2023 anatomy review describes the injection as a small dose placed deep at the base of the columella, close to the bone. It also names what can go wrong when the toxin reaches neighbouring muscles: the upper lip can droop, and chewing and speaking can become harder for a time.

In the UK, botulinum toxin is a prescription-only medicine. According to the Joint Council for Cosmetic Practitioners, it must be prescribed by a doctor, dentist, nurse prescriber or pharmacist prescriber, and the effect typically lasts 3 to 4 months. In England, the law also restricts giving it to anyone under 18.

Botox is not filler. Filler adds volume, and its limits and risks are on the non-surgical rhinoplasty page. Botox only weakens a muscle.

Can rhinoplasty improve a smile?

It may, though the evidence is thin. A study at Hatay Mustafa Kemal University in Turkey measured 27 adults before rhinoplasty and at 1 and 6 months afterwards. On a full smile, less gum showed and the distance between the upper front teeth and the lip was shorter at both points. The authors concluded that rhinoplasty can improve how a smile looks.

Two cautions. We could read only the study's abstract, which gives no figures. And whether showing less gum is an improvement depends on how much showed to begin with.

A smile in a before and after photograph is one expression, taken once. The post on how to read a before and after photograph explains what else to check.

Does rhinoplasty change your whole face?

It does not change the bones of the face or its other muscles of expression, but it changes how the rest of the face reads. The nose sits in the middle of the face, so a different tip changes how the upper lip and chin look beside it. The results page sets out what surgery can and cannot change.

What only an examination can settle

Whether your tip already drops when you smile is a question for before surgery, and a still profile photograph cannot answer it. A smiling photograph and a few seconds of video can.

An examination also settles whether the muscle can be felt working, how thick the skin and soft tissue are at the base of the nose, and whether you breathe freely on both sides. The breathing guide covers the last of these.