Droopy nasal tip — drooping, and dropping when you smile

What holds the tip up

The direction of the tip depends on a support system: the alar cartilages, the area where they attach to the end of the septum, and the surrounding connective tissue. When that system is strong the tip sits up; when it is weak, either from the start or with time, the tip turns down.

Tip position is described with two measures: rotation (up-and-down direction) and projection (how far the tip stands forward from the face). The same complaint of a "droopy tip" is a rotation problem in some noses and a projection problem in others, and correction differs accordingly.

A tip that drops when you smile

Between the upper lip and the tip there is a small muscle that pulls the tip down when it contracts (depressor septi nasi). In people where it acts strongly, the tip looks normal at rest but drops noticeably on smiling, and the upper lip appears shortened.

This can be independent of the cartilage structure. Assessment therefore looks at the smiling face as well as the resting one, because most people see themselves smiling in photographs.

How lifting the tip affects breathing

The tip region is one of the narrowest parts of the airway. If the alar cartilages are weak, the sidewalls can collapse inwards on inspiration; supporting the tip then improves appearance and airflow together.

The reverse is also true: reducing a tip without thinking about support weakens the sidewalls and can cause collapse on breathing in. In tip surgery, "making it smaller" is therefore not a goal in itself; the goal is a supported, balanced tip.

• Thickness and strength of the alar cartilages
• Length of the septal end and how much of the tip it carries
• Skin thickness: thick skin reduces the visible effect of a lift
• Whether the sidewalls collapse on inspiration
• Upper lip length and how the tip moves on smiling

How far should it be lifted?

An over-rotated tip turns the nostrils forwards and becomes more obvious over the years. It is among the harder appearances to correct. The amount of lift is therefore kept measured, against facial proportions, the patient's age and the profile line.

Tip support naturally decreases with age. A plan made in the twenties takes that into account: a tip that looks exactly right today can droop again years later if it is not supported.

Is tip surgery alone enough?

In some noses, yes: if the bridge is smooth and the only issue is the direction of the tip, an operation limited to the tip can be planned. In others, a low tip creates the impression of a hump that is not really there, and lifting the tip straightens the profile by itself.

The opposite also happens: with a marked hump, lifting only the tip can upset the balance. The purpose of the consultation is to separate what belongs to the tip, what belongs to the bridge, and what belongs to both.

Recovery

1. First 2 weeks The tip looks thicker and higher than it will be; this is temporary.
2. 3-6 months Tip swelling begins to resolve and direction and proportion emerge.
3. 12-18 months The tip is the last area to settle, particularly with thick skin.

These are average times; recovery varies from person to person.