Treatment of hyperdynamic nasal tip ptosis in open rhinoplasty: using the anatomic relationship between the depressor septi nasi muscle and the dermocartilaginous ligament

Tellioglu AT, Inozu E, Ozakpinar R, Eryilmaz T, Esmer AF, Sen T, Tekdemir I.

What this paper says

Of 100 primary rhinoplasty patients, 36 had a tip that dropped on smiling from an overactive depressor septi muscle, and cutting that muscle through the open approach, guided by a ligament that leads to it, corrected the droop and reduced gum show without narrowing the columella.

Overview

In some people, smiling pulls the nasal tip down, shortens the upper lip and shows more gum. The depressor septi muscle causes this. It is usually reached through a cut inside the mouth. The authors used the dermocartilaginous ligament, which runs from the upper nose down into that muscle, as a guide to find and remove it during open rhinoplasty.

Sections of note

100 primary rhinoplasty patients assessed; 36 had hyperdynamic tip ptosis from a hyperactive depressor septi nasi muscle.
The muscle was reached in open rhinoplasty by following the dermocartilaginous ligament; excision done just below the footplates of the medial crura.
A strong columellar strut was placed between the medial crura to keep columellar width and resist any remaining muscle pull.
No early infection or hematoma.
The technique corrected the droop, increased upper lip length and decreased gum show on smiling.
No columellar narrowing and no depression at the columella-lip junction.
Level of evidence IV; the abstract gives no follow-up length or measurements.

What it means for a patient

If your nose tip dips and your lip shortens when you smile, the cause is a small muscle that can be released during rhinoplasty without a separate cut inside the mouth.
In this series the fix worked without visible side effects, per the surgeons' assessment.
No measurement of the change is given and follow-up length is not stated.

Why this paper matters

The depressor septi release is a well known adjunct; this paper offers an anatomic landmark that makes it reliable through the open approach. Objective measurement of tip movement and long-term recurrence are not reported.

Terms

Depressor septi nasi muscle: a small muscle from the upper lip to the base of the septum that pulls the tip down on smiling.
Hyperdynamic tip ptosis: drooping of the tip that appears only with facial movement.
Dermocartilaginous ligament: a fibrous band running from the upper nose down the midline into the depressor septi muscle.
Medial crura: the inner legs of the tip cartilages, running down the columella.
Columellar strut: a cartilage rod placed between the medial crura to support the tip.
Gingival show: the amount of gum visible when smiling.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Smiling causes a deformity in some rhinoplasty patients that includes drooping of the nasal tip, elevation and shortening of the upper lip, and increased maxillary gingival show. The depressor septi muscle leads this deformity. The dermocartilaginous ligament originates from the fascia of the upper third of the nose…”

Excerpt; the full abstract is on PubMed.