Why the Tip Droops Again After Rhinoplasty — the Depressor Septi Muscle and Revision Design
2024. 2. 16.
Why the tip droops over time even after the nose is raised (the depressor septi muscle acting when you smile or speak), and how tip material, alar, and forehead balance are judged when designing a revision.
Key points
- Even after the tip is raised with rhinoplasty, the muscle that pulls the tip downward (the depressor septi) acts every time you smile or speak, continuously generating pressure.
- Correction can be considered when muscle influence is significant, but removal can't be guaranteed to reliably prevent drooping — the existing support structure and scar condition must also be examined together.
- The scope of revision is decided by "what remains" — the material used in the first surgery, alar reduction already performed, and surrounding areas seen together with the nose like the forehead and glabella.
Years after rhinoplasty, some people feel that "the tip seems lower than it was at first." What felt like slightly insufficient height can become more distinct over time; from the side the tip may look droopy, or the nose spreading when smiling can become a concern. This article organizes why that change happens — and what gets examined together when designing a revision.
01
If the nose spreads when smiling, why does the muscle get examined?
Tip position isn't determined only by the structure built in surgery. Every time you smile or speak, a muscle that pulls the tip downward acts, continuously generating pressure.
Compared to people in whom this muscle isn't developed, when it is developed tip drooping occurs far more frequently — so many people end up considering revision because the tip has dropped. That's why if the nose spreads when smiling and the tip descends, correction or removal of the depressor septi muscle may be needed.
Depressor septi correction can be considered, but whether the drooping cause is the muscle alone and how much effect is possible should be explained after evaluating expression movement and the existing support structure.
02
What does revision design take into account?
Revision doesn't end at rebuilding height. Since the nose has already been operated on once, the remaining conditions are organized first, then only the needed scope is planned.
| Item | Decision criteria |
|---|---|
| Tip material | If donor rib cartilage was used in the first surgery, raising the tip with donor rib cartilage again in revision can be judged feasible |
| Surgical approach | Because the structure must be examined and handled directly, it may proceed as open surgery |
| Alar reduction | If already done in the first surgery, it isn't added again in revision |
| Depressor septi muscle | Whether spreading when smiling and tip drooping accompany it is checked before judging correction or removal |
| Forehead · glabella | If the forehead is flat and the glabella low, dissonance with the bridge can arise — forehead fat grafting may be combined |
The goal of tip design is refining the tip slim and gathering it so the nose's width doesn't look wide from the front; from the side, a defined nasal line and the flow of the forehead and glabella are reviewed together. Criteria for choosing revision materials are covered in more detail in the materials guide. Actual before-and-after changes can be seen in the before-and-after photos.
03
Summary — revision starts with "why did it drop"
If you're considering revision because the tip has dropped, it's not about rebuilding height alone — first look at why it dropped. If the nose spreads and droops when smiling, the depressor septi muscle's action is checked together, and the design considers the materials used in previous surgery plus surrounding balance like the forehead and glabella.
Frequently asked questions
Answers to common questions patients ask before a consultation.
If donor rib cartilage was used in the first surgery, is the same material used in revision?
Why does the tip drop as time passes after surgery?
Does alar reduction need to be redone in revision?
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.