Thank you for the question and the photo.
Although it is hard to tell without a physical exam and there is also some asymmetric lighting in the photo. IT seems like your left upper lip is thinner and some filler may help mask the asymmetry. Ultimately, there may be some gum line asymmetry or actual underlying skeleton asymmetry.
A gum line asymmetry can be improved with crown lengthening (trimming of the gum around the teeth). I do not think this is your case.
A skeletal asymmetry can be corrected with jaw surgery. However, given the subtle nature of you asymmetry, this surgery would likely not be warranted (unless you have bite or jaw joint issue).
Warm Regards,
Hardeep Dhaliwal, MD, DMD
Thank you for sharing a great questions. Although most botulinum toxin (botox) injections for the masseter are performed at the lower portion of the muscle, upper portions can be injected with care in certain patients.
However, a thorough examination of your face or facial photos may help us understand the exact portion of the face you want reduced. I suspect a buccal fat (Bichet's fat pad) reduction may also give you the look you are trying to achieve. Another option would be augment the lower part of the jawline with filler to give the illusion of reduced volume in the mid-lower section of the face. A combination of filler and a buccal fat pad reduction may also give you the look you are trying to achieve.
Warm Regards,
Hardeep
Thank you for the great question.
You have the essence of what needs to be done to achieve facial harmony.
To achieve this goal it would be ideal to treatment plan your surgery with a thorough facial and dental examination which includes cone beam CT (bone imaging) imaging and 3D facial photography (at rest and in smile).
In General, we want the facial thirds to be close to equal. If you type in "facial thirds" into any search engine, you will see what I am referring to. Thus, a counter-clockwise rotation as you discussed would be would be ideal, however the amount you showed (and direction) may shorten your lower facial third too much (but its hard to tell without seeing photos of your entire face).
To achieve this rotation, you will almost certainly need a double jaw (upper and lower jaw) surgery. Double jaw surgery allows one to achieve complete control of lower facial third and achieve the ideal facial balance and harmony.
An experienced maxillofacial surgeon familiar with counter-clockwise movements and well versed in virtual surgical planning should be able to give you the result you are looking to achieve.
Thank you for the question.
It would be ideal to see photos taken prior to the injection of filler.
Allow for some healing time, then you may be able to get a satisfactory result form a lower transconjunctival bleoharoplasty and/or conservative fat grafting.
If you have fat grafting performed, ensure it is done by an experienced surgeon.