Q: Dr. Eppley, I would like to inquire about depressor septi release surgery for correcting a transverse crease above my upper lip just below my nose. I do not know of this is the right approach but ti seems like it might work.
A: The release/removal of the depressor septi nasii muscle is usually done to stop the top of the nose from pulling down while smiling. It may or may not have an effect on a transverse crease in the upper lip. The best way to find out if it does is to initially do Botox injections first and prove that the elimination of its action will make an improvement. If Botox is successful then you should consider depressor septi muscle release surgery
Dr. Barry Eppley
Q: I will be having nose surgery soon and one thing my doctor recommended was to cut the muscle that makes my nose tip droop when I smile. While this has been told to me as a simple step in the surgery, I am worried that my smile or, more specifically, the way my upper lip moves will be abnormal after the procedure. From your nose surgery experience have you ever seen this to be a problem?
A: For some patients, they have a hyperactive or large depressor septi muscle that pulls the tip of the nose downward when they smile. This is often resolved during rhinoplasty surgery when the tip of the nose is made stiffer through cartilage grafts and sutures, a secondary benefit from the primary objective of nose tip reshaping. One simple way to ensure that this result happens is to also release the bony attachment of a tiny muscle that runs from the tip of the down to the upper jaw bone, the depressor septi muscle. This muscle is not one of the smile muscles and has no role to play in how one’s mouth or lips moves. However, because the dissection to get to the muscle goes through a portion of the upper lip (either underneath the lip through the frenulum or from inside the nose), there will be some swelling of the lip for several weeks afterward. This swelling will temporarily affect the shape of the upper lip and may make the smile more ‘stiff’ until it goes away. But releasing this muscle will in no way affect how one smiles once it is healed.
Dr. Barry Eppley