Why the Nose Droops Again After Arrow Nose Surgery — The Depressor Septi and Levator Labii Alaeque Nasi Muscles

2025. 3. 7.

The role of the depressor septi and levator labii alaeque nasi muscles that can affect the drooped feel after arrow nose surgery — why movement in expression is checked and the need for muscle adjustment is judged individually.

Key points

Looking drooped again after arrow nose surgery can involve not only support structure and tissue changes but also the expressive action of the depressor septi and levator labii alaeque nasi muscles.
The depressor septi pulls the tip downward, and the levator labii alaeque nasi lifts the alae upward — viewed from the side it becomes a tip drooping and alae rising appearance.
Muscle adjustment is not a required step for everyone — necessity and range must be decided by comparing the resting state and movement in expression.

After arrow nose surgery, there are cases where the tip comes down again over time and becomes a drooped nose. It is easy to think only the tip's shape or height is the problem — but what gets pointed to as the cause here is the muscles around the nose.

This article organizes the depressor septi muscle that causes the drooped nose after arrow nose surgery, and the levator labii alaeque nasi muscle examined together with it.

What causes the drooped nose after arrow nose surgery?

Several causes contribute to looking drooped after arrow nose surgery — among them, the muscles checked in expression are the depressor septi and the levator labii alaeque nasi.

Muscle	Location	Role
Depressor septi (nasal tip depressor)	From the columella toward the philtrum	Pulls the tip downward
Levator labii alaeque nasi	Both sides of the nose	Lifts the alae upward

The depressor septi is also called the nasal tip depressor — located from the columella toward the philtrum, it pulls the tip downward. The levator labii alaeque nasi is located on both sides of the nose and lifts the alae.

When the two muscles act together, viewed from the side it becomes an appearance where the tip droops downward and the alae rise upward. It is also why the degree to which the tip looks drooped differs by expression.

Why does muscle treatment matter in arrow nose surgery?

If the tip drops further or the alae rise when smiling compared to the resting state, the muscle action is evaluated together. However, whether to preserve or adjust the muscle, and to what range, differs by anatomical structure and expressive function. What is checked together in tip correction can be seen in more detail in the nasal tip surgery guide.

Is it okay to cut the muscle?

Because the muscles are involved in expression and lip/alar movement, it cannot be uniformly said that cutting them is mostly problem-free. The need for adjustment, expected change, and the possibility of expression asymmetry or movement change must be explained and the range decided.

To summarize:

Depressor septi (nasal tip depressor) — how much it pulls the tip downward in expression is checked.
Levator labii alaeque nasi — how much the alae rise when smiling and the left-right difference are checked.
Whether to adjust the muscles — judged individually, including whether support-structure correction alone is sufficient and the possibility of expressive function change.

Summary — we look at the muscles, not just the shape

The cause of looking drooped after arrow nose surgery must be viewed across support structure, tissue change, and expression muscles together. Muscle adjustment is not an automatically attached step — it must be judged individually by checking the resting/expression states and the possibility of functional change.

If you are curious whether muscles are involved in your tip droop, it can be checked in a 1:1 video consultation. Actual correction cases can be seen in the before-and-after photos.

Frequently asked questions

Answers to common questions patients ask before a consultation.

What is the depressor septi muscle?

Another name for the depressor septi. A muscle running from the columella toward the philtrum that pulls the tip downward during expression. When this muscle's action is prominent, tip droop when smiling can stand out more.

What happens if the muscles are not treated in arrow nose surgery?

If the depressor septi is left as is, the force pulling the tip downward remains after surgery, so the nose can keep lowering or become a drooped nose. If the levator labii alaeque nasi is left, the alae can rise when smiling making the tip relatively look drooped.

Does cutting nose muscles cause problems with expression or function?

Because the muscles are involved in expressive movement, the effect of cutting cannot be uniformly concluded. The current movement, adjustment range, and possibility of expression change must be confirmed with the medical staff.

Responses to treatment and recovery progress vary by individual. Outcomes and side effects vary from person to person. Bleeding, infection, swelling and asymmetry may occur. Please consult our medical team before making a decision.

Back to the list