Q: Dr. Eppley, I am interested in depressor septi muscle surgery. When I smile the tip of my nose really gets pulled down. Also my upper lip crunches up and a wrinkle appears across the top of my upper lip. I have read online that this is due to a muscle under the nose and if it is released my nose and lip will look better when I smile. How is this surgery done?
A: The muscle you are referring to is the depressor septi muscle. It is attached from the upper jaw at the base of the nose upwards where it attaches to the nasal septum and the back part of the nasalis muscle. It is this muscle then when overactive pulls the tip of the nose down an pulls up on the upper lip which sort of crunches the nose and lip together. In rhinoplasty this is known as the smiling deformity.
This smiling deformity is often treated at the time of a rhinoplasty or can be done as an isolated procedure. The surgical techniques for treating an overactive depressor septi nasi muscle vary and consist of either an(intranasal resection or an intraoral release/transposition. A recent study has shown that the both techniques produce similar effects in how much they decreased the effects of smiling on the length of the nose, tip projection or upper lip length.
The intranasal approach is historically more common due to the anatomic location of the muscle when doing a closed rhinoplasty. It has a side benefit of decreasing the interalar distance. The intraoral approach has been more recently described undoubtably due to the now widespread use of open rhinoplasty. Coming from below (inside the mouth) allows an actual release and transposition of the paired muscles. This results in an increased fullness to the upper lip afterwards.
Either depressor septi muscle surgery techique can be done under local or IV sedation and has a minimal recovery with some short-term upper lip swelling.
Dr. Barry Eppley