Nasal Tip Drooping When Smiling: Detailed Guide

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 27.09.2026

The depressor septi nasi muscle

The depressor septi nasi is a small muscle that arises from the ring muscle in the middle of the upper lip (orbicularis oris) or from the front surface of the upper jaw and runs upwards to attach to the base of the columella, the bridge between the nostrils, and to the inner legs of the cartilages that form the nasal tip. When it contracts it pulls the tip down and back, slightly narrows the nostrils and shortens the upper lip upwards. Everyone has this muscle, but its strength, structure and attachment vary from person to person.

Anatomical studies have shown that the muscle comes in different types: in some people it blends with the lip muscle on its way to the columella, in others it arises directly from the surface of the upper jaw, and in others it is very weak or almost absent. Marked drooping of the tip on smiling is more common in people in whom the muscle is strong and attaches directly to the tip cartilages.

What holds the nasal tip up?

The position of the nasal tip depends on the balance between the structures that hold it up and the forces that pull it down. The main supports are the strong inner legs of the lower lateral cartilages that form the tip, the connection of these cartilages to the front end of the nasal septum, and the structure of the tip skin. The depressor septi nasi is a dynamic force that tips this balance downwards. When support is strong, the muscle’s effect is hardly noticeable; when support is weak, even a small contraction can lower the tip markedly. This is why treatment has to consider not only the muscle but also the support.

Signs

The most typical finding is a nasal tip that sits normally at rest but drops when smiling; in profile the nose looks longer and lower. The upper lip shortens when smiling and more of the gum may show; in some people a horizontal crease appears in the middle of the upper lip just below the base of the nose. The angle between the tip and the lip narrows on smiling. People usually notice it in photographs or in the mirror while smiling. It does not cause nasal blockage or any other health problem; it is purely a matter of appearance.

Examination and assessment

Dynamic examination: The nose is examined from the front, side and below, both at rest and during a broad smile; the difference between the two is documented with photographs or a short video. These records are also used for comparison after treatment.

Finger test: While the patient smiles, gentle finger pressure is applied to the middle of the upper lip just below the base of the nose. If the tip no longer drops under pressure, the muscle’s effect is dominant and treatment aimed at the muscle is expected to help; if drooping continues despite the pressure, weak tip support is the main issue.

Assessment of support and proportions: The strength of the cartilage support is judged by pressing gently on the tip. The structure of the front end of the septum, the angle between the tip and the lip, the length of the upper lip, gum show and overall facial proportions are noted. In patients planning rhinoplasty, an internal nasal examination and breathing assessment are done at the same visit.

Treatment options

Botulinum toxin

A small injection into the muscle, through the middle of the upper lip or the base of the columella, reduces its pull. The effect begins within two to seven days, usually lasts three to six months and then fades; a lasting result requires regular repeat injections. It is an option for people who do not want surgery, and before surgery it also shows in advance how much the tip will change when the muscle is switched off. Possible side effects are temporary and usually mild: slight bruising at the injection site, brief asymmetry of the smile or a temporary feeling of weakness in the upper lip. These settle as the effect wears off.

Muscle surgery

The muscle’s effect on the tip is removed either by releasing its attachment or by repositioning the muscle and stitching its two halves together (transposition). Release stops the muscle’s pull; in repositioning, the muscle is placed so as to create fullness and support in the middle of the lip, which can also reduce the shortening of the upper lip on smiling. This step is carried out during rhinoplasty.

Strengthening tip support

In most patients, drooping of the tip on smiling is due not only to the muscle but also to weak tip support; in that case treating the muscle alone gives a limited result. In these patients, grafts are used during rhinoplasty, usually made from cartilage taken from the septum: a strut graft placed between the inner legs of the tip cartilages (columellar strut) or an extension graft fixing the tip to the front end of the septum (septal extension graft) keeps the tip in place both at rest and when smiling. Which method is needed depends on the support assessment at examination and the patient’s goals for the tip.

Recovery

After botulinum toxin: Daily life resumes immediately. For the first few hours it is advisable not to massage the injection area and not to lie face down. The effect settles within a few days, during which the smile may feel slightly different.

After surgical treatment: Recovery follows the rhinoplasty timeline. For the first few weeks the smile may feel a little different, becoming natural as the muscle heals. Swelling of the tip subsides over weeks; the final shape of the tip and how it behaves when smiling become clear over months as swelling fully settles.

Possible problems

After muscle surgery there may be temporary numbness of the upper lip, a short-lived change in the smile and, rarely, a healing problem at the incision. If the muscle’s strength is not reduced enough, some drooping on smiling may persist. With botulinum toxin the effect is not permanent, so things gradually return to how they were. In rhinoplasty with grafts the risks are the general risks of rhinoplasty; among them are a tip that feels firmer than desired or slight asymmetry related to a graft, which often improve with time or a minor correction.

Frequently asked questions

Is a drooping tip when smiling a disease? No. It is a feature related to muscle structure and does not affect breathing or health. Treatment is planned entirely around the patient’s expectations about appearance.

Will botulinum toxin change my smile? When given at the right dose and point, the aim is only to reduce the effect of the muscle that pulls the tip down; the smile itself is preserved. A slight difference in the upper lip may be felt in the first days; this is temporary.

Is muscle surgery alone enough? It may be enough in patients whose tip support is strong and whose drooping comes mainly from the muscle. In patients with weak support the tip also needs strengthening with grafts; the finger test and support assessment at examination make this distinction.

Can it be treated without rhinoplasty? The option that can be used without rhinoplasty is botulinum toxin, and its effect is temporary. For a lasting solution, treatment of the muscle and, when needed, strengthening of tip support are carried out during rhinoplasty.

My tip drops when I smile after rhinoplasty. What can be done? First it is assessed whether the drooping comes from the muscle or from insufficient tip support. If the muscle is dominant, botulinum toxin or muscle surgery is considered; if support is insufficient, strengthening the tip with grafts in revision rhinoplasty. For revision, at least a year after the first operation is usually awaited.

Is the result permanent? The effect of botulinum toxin is temporary. Muscle surgery and tip support built with grafts aim for a lasting result.

This article is for general information; please consult your physician for diagnosis and treatment.