A wide nose for the most part can really only be improved by surgical treatment via a rhinoplasty. I would recommend that if you are interested in treating a wide nose, that you seek out a very experienced rhinoplasty surgeon, especially one that can perform computer generated imaging as I feel this really aids not only the patient in understanding the expected outcome, but also really aids the surgeon in creating an appropriate plan for the patient’s anatomic features. The deep smile lines can be treated in multiple different ways, the easiest of which is through the use of injectable fillers such as Restylane and Juvéderm. These filler materials can be placed in the fold of the smile line and used to fill in the depression and virtually rid the patient of this concerning area. The only downside of these types of fillers is that they are temporary, but they will typically last nine to twelve months and overall are a very good value. A more sophisticated approach toward treatment of the smile lines would be placement of the patient’s natural tissue whether that be by fat grafting or if the patient has significant features of aging, we can harvest portions of the fibrofatty tissue beneath the skin during a facelift and place this under the smile lines for a more permanent improvement of this area. A more sophisticated approach to treatment would be an extended SMAS deep place facelift, which is really the only surgical technique of a facelift that can improve the smile lines long term. I have had many patients with extremely significant improvement in their smile lines after an extended SMAS deep place facelift, but overall I discuss with my patients the fact that they can expect a one out of four improvement in this area in that if they have severe smile lines, they can expect moderate smile lines after the procedure and if they have moderate smile lines, they can expect mild smile lines after the deep plane facelift. I have however seen many patients get a more significant improvement. The only other option that will create significant improvement would be direct excision of these folds where the soft tissue is literally removed and then sutured resulting in a relatively inconspicuous, yet visible scar in this area. For the most part, I tend to condemn this treatment as most patients do not find the scar to be an acceptable alternative to the smile line fold.
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