What is nasal tip elevation botulinum toxin?
Nasal tip elevation botulinum toxin is a procedure based on temporarily reducing the movement of the muscle that pulls the nasal tip downwards when smiling. Whether any change can occur in the appearance of the nasal tip is assessed at the examination.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces contraction of the muscle into which it is administered. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
This procedure does not change the structure of the nose. It is not directed at the bone and cartilage structure of the nose, at its size, or at the shape of its dorsum. The only thing assessed is whether or not the movement that appears during smiling is reduced. The expected change is limited and may not be seen in every person.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The factors that determine the assessment in this area are:
- Whether or not the nasal tip moves downwards during smiling
- The position of the nasal tip at rest
- Upper lip movement and the distance between the nose and the upper lip
- Whether there is a history of nasal surgery
- Procedures previously performed on the area
If no movement is seen in the nasal tip during smiling, no contribution can be expected from this procedure; this is stated clearly at the consultation.
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- A nasal tip that does not move during smiling
- Active infection, an acne lesion or an open wound
In these situations, the procedure is planned subject to the physician’s assessment:
- Previous nasal surgery (the movement and sensation in the area may have changed)
- An existing problem or asymmetry in upper lip movement
- A long distance between the nose and the upper lip (the procedure may make this appearance more pronounced)
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
- A nasal complaint affecting breathing (an assessment by the relevant specialty may be required)
If nasal surgery has been carried out and healing is still ongoing, the procedure is postponed.
How is the procedure performed?
- Assessment. The movement of the nasal tip during smiling is observed; if there is no movement, no procedure is planned. Upper lip movement, the distance between the nose and the upper lip, any history of nasal surgery and previous procedures are assessed. Any history of neuromuscular disease, current medication and known allergies are recorded. Blood pressure and pulse are measured.
- Product check. The authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The procedure, the fact that the expected change is limited, the temporary nature of the effect, the possibility of a change in upper lip movement and of asymmetry of the smile and the possible side effects are explained in writing and verbally; the form is signed.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Administration. The product is administered to the determined point with a fine needle.
- Observation and follow-up. Vital signs and anything observed are recorded in the file. A follow-up appointment is arranged at which the outcome will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full outcome is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The duration of the effect in this area may differ from that in other areas of the face; this is discussed beforehand. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
If you have a history of nasal surgery, please state its type and date.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- You are advised not to wipe the nose frequently, and to avoid blowing the nose for a while
- If you wear glasses, take care that they do not press on the nose
- Bending forward, remaining head-down for long periods and lying face down should be avoided for the period specified
- Avoid hot environments, saunas, sunbeds and intense exercise for a while
- A temporary raised bump, redness and slight bruising may occur at the point of administration
Advice and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
Risks specific to this area
- A change in upper lip movement (a reduction in the lifting of the lip)
- Asymmetry of the smile
- An unexpected appearance of the upper lip during smiling
- Temporary difficulty in producing certain sounds when speaking
- A temporary feeling of tightness in and around the nasal tip
- The expected change not being seen (the outcome at the nasal tip is limited and may not appear in every person)
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- A change in facial expression
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Marked asymmetry of the smile
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Does nasal tip elevation botulinum toxin make my nose smaller?
No. This procedure is not directed at the bone and cartilage structure of the nose, at its size, or at the shape of its dorsum. The only thing assessed is whether or not the movement that pulls the nasal tip downwards during smiling is reduced.
How much change is expected from this procedure?
The expected change is limited and may not be seen in every person. If no movement is seen in the nasal tip during smiling, no contribution can be expected from this procedure; this is stated clearly at the consultation.
Will nasal tip botulinum toxin affect my smile?
A change in upper lip movement and asymmetry of the smile are among the side effects reported in this area. For this reason, upper lip movement and the distance between the nose and the upper lip are assessed before the procedure.
I have had nasal surgery; can I still have this procedure?
In those whose healing is still ongoing, the procedure is postponed. In those who have had surgery, the movement and sensation in the area may have changed; please state the type and date of your operation at the consultation.
How long does the effect of nasal tip botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. The duration of the effect in this area may differ from that in other areas of the face; this is discussed before the procedure. The timing of any repeat is determined at the follow-up consultation.
Can I blow my nose after the procedure?
After the procedure, you are advised not to wipe the nose frequently and to avoid blowing it for a while. The time period specific to you is given in writing at the end of the procedure.
Is nasal tip elevation botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
