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A lot of patients come in saying, “I hate how my nose looks when I smile.”
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But usually the smile itself is not the problem. When you smile, your entire
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face changes. The cheeks lift, the upper lip moves, the nostrils widen, and the
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skin and soft tissues of the face stretch. The muscles of facial
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expression naturally pull on the nose and upper lip during a smile. And that
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movement can exacerbate features of the nose that may be more subtle at rest,
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like a bump, asymmetry, width issue, or a specific tip shape. It may be that the
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smile is just highlighting an issue with your nose that is actually more
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tolerable at rest. Importantly, some widening of the nostrils when smiling is
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completely normal and it’s dependent on your individual facial muscle anatomy
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and your natural smile pattern, which is an important part of facial expression
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and identity. And honestly, smiling is universally perceived as attractive. So,
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why would you change it? Another thing to remember is that phone cameras
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exaggerate this stuff. Wide-angle lenses, especially on iPhones at close
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distance, distort facial proportions and often make the nose look larger or wider
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in smiling photos. We treat patients and not photographs. Now, there is one
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specific issue that surgery can address, and that’s when the nasal tip noticeably
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plunges downward during a smile. That’s related to the muscles around the upper
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lip and nasal base. And in selective patients, that dynamic movement can be
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improved with surgery. But in general, we can’t and shouldn’t try to create a
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completely different smiling nose without also considering the appearance
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of the nose at rest. The goal of rhinoplasty is a nose that looks natural
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and balanced, both when your face is relaxed and when you’re expressive and
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smiling.