Nasal Tip Drooping When Smiling

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

What is it?

In some people the nasal tip looks normal at rest but drops noticeably when they smile or talk; seen from the side the tip looks low and “beak-like”, the upper lip shortens and sometimes a horizontal line appears in the middle of the upper lip. This is called dynamic nasal tip drooping. The main cause is the depressor septi nasi muscle, which runs from the middle of the upper lip to the base of the columella, the bridge of skin between the nostrils. When this muscle is strong, or when the structures supporting the nasal tip are weak, the tip is pulled down during smiling.

Who is affected?

It is usually an inborn feature, and people often come in after noticing that their nose looks different in photographs when they smile. It is more pronounced in people whose tip support is weak or whose tip is already low or long. As tip support weakens with age, drooping on smiling may increase. It can also become noticeable after a previous rhinoplasty in which tip support was not sufficiently reinforced. It is often seen together with a gummy smile and a short upper lip.

How is it assessed?

The key is a dynamic examination: the nose is examined from the front and side at rest and while smiling, and photographs or a video of both may be taken for comparison. During the examination, gentle finger pressure on the middle of the upper lip temporarily cancels the muscle’s pull; if the tip no longer drops, the problem is largely muscular. The support of the tip cartilages and the septum, the angle between the tip and the lip, and the length of the upper lip are also assessed.

Treatment options

Botulinum toxin: A small injection into the muscle reduces its pull. The effect begins within a few days and usually lasts three to six months; it is not permanent and needs repeating. It is an option for people who do not want surgery, and it can also be used before surgery to preview the result.

Surgery: The muscle’s pull on the tip is stopped by releasing its attachment or repositioning it. This is done during rhinoplasty. In most patients treating the muscle alone is not enough and the tip support also needs to be strengthened with cartilage grafts; both are planned together in the same operation.

Link with rhinoplasty

When planning rhinoplasty, the nose should be assessed not only at rest but also while smiling. If drooping on smiling is overlooked, the tip may look good at rest after surgery yet continue to drop when the patient smiles. When the muscle’s effect and tip support are addressed together, the aim is a balanced tip both at rest and in a smile.

Recovery

After botulinum toxin, daily life resumes immediately; a slight difference in the upper lip may be felt when smiling during the first days. After surgical treatment, recovery follows the rhinoplasty timeline; the smile may feel a little different in the first weeks, and the final shape of the tip becomes clear over months as swelling settles.

When to see a specialist

If you notice that your nasal tip drops or your upper lip shortens when you smile, or that your nose looks different in smiling photographs, an ENT assessment can establish whether the cause is the muscle or the tip support. If you are considering rhinoplasty, be sure to mention it at your consultation, as it directly affects the plan.

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