Drooping nose tip after Botox: why, how long and what to do

Do you feel that the tip of your nose has been lower since a botulinum toxin injection, or that it drops further when you smile? This worry is one of the nose problems after an injection that people may come across. It is worth knowing from the outset that studies mostly describe the opposite: the toxin is sometimes used to slightly lift a nose tip that drops when smiling. A tip that looks lower after an injection therefore has several possible explanations, which this page goes through, without replacing an examination by your doctor.

Why can the nose tip look droopy?

The position of the nose tip depends partly on a small muscle, the depressor septi nasi, located at the base of the septum. When it is very active, it pulls the tip downwards, especially when you smile¹. A systematic review of studies on botulinum toxin in the nose reports that a deep injection at the base of the septum can slightly lift the tip; it recommends keeping this procedure for tips that drop clearly when smiling¹. Another review confirms that relaxing this muscle can reduce the drop of the tip². Several experts in a global consensus, however, regard lifting the tip with toxin as a complementary procedure, secondary to fillers³.

Based on these data, three situations can explain the impression of a drooping tip after an injection:

• the effect wearing off: if the toxin had been injected to lift the tip, the tip returns to its original position as the effect fades; in studies, this effect lasted 2–5 months¹;
• a change in the upper lip: spread of the toxin from the base of the septum to the lip muscles can flatten the groove between the nose and the lip, make the lip uneven or make it droop¹, which changes the balance of the lower nose;
• a less clear-cut result than hoped: the review notes that the immediate effect is subtle and that most studies had no comparison group¹.

None of the sources we consulted describes the tip dropping as a direct result of the toxin. Finally, nose injections are not among the indications in the French product labels, which are limited in aesthetic use to frown lines and, depending on the product, crow’s feet and the forehead⁴: it is an off-label use.

How soon after the injection does it appear?

If it is linked to the effect of the toxin on a neighbouring muscle, it appears as this effect builds up, usually within the first week^4,5. If it reflects the end of a lifting effect, it is noticed several months after the injection¹. No source gives a timeframe specific to this situation.

How long does it last?

An effect of the toxin on a neighbouring muscle lasts at most as long as the product acts; in studies of the nose tip, the intended effect lasted 2–5 months¹. If the impression comes from the tip returning to its original position, this is not a side effect but the state before treatment. The page on how long botulinum toxin lasts explains what the duration of action depends on.

Is it reversible?

The effects of the toxin are temporary: transmission between nerve and muscle is gradually restored⁶. In a review of 35 clinical studies, the lip imbalances linked to lower-face treatments all resolved on their own⁷. A tip that has returned to its original position, however, will not "rise again" by itself: this is its natural position.

Is there a treatment?

It all depends on the cause, which requires an examination. If the upper lip is involved, you usually have to wait for the effect to wear off. If the tip has simply returned to its original position, the question of a new treatment is a matter for a consultation, with no urgency. No massage or exercise has shown any effect in the sources we consulted.

What should you avoid?

• Do not ask for another injection soon afterwards without an examination: the effect of toxins given a few months apart is not known, and weakness can be made worse by a toxin injected before the effect of the previous one has worn off⁵.
• Do not judge your nose from a single photo or a single angle: compare dated photos taken in the same conditions, at rest and smiling.
• Do not manipulate the nose tip to "put it back in place".

When should you see a doctor?

Talk to the doctor who performed the injection if the change bothers you, if it comes with a less mobile upper lip or difficulty eating or drinking, or if it does not improve. Bring the date of the injection, the area treated and any "before" photos you have. Difficulty swallowing, a changed voice, difficulty breathing or a problem with your vision are warning signs: call emergency services (15 or 112 in France, or your local emergency number).

If it was rather the lines of the upper nose that were treated, see the page on overdone bunny lines. If your upper lip covers more of your teeth when you smile, the page on the overcorrected gummy smile describes a related mechanism.