I have severe asymmetrical mouth and smile. What are some surgical possibilities to address this? (Photo)

Question

I assume this is a genetic assymetry. I've always had it. Botox is not a viable option to address the assymetry. I do not have muscle control on that certain side for some reason.

Jason Emer, MD · Answer

I suggest botox lightly to the other side or fillers to help balance.  I suggest you see a cosmetic dermatologist with experience in facial contouring.  Best, Dr. Emer.

Christian L. Stallworth, MD · Answer

awalter86- thanks for you question.  Your photos demonstrate an asymmetric weakness of your right lower lip, which doesn't retract/depress like the left when smiling.  Based on its presence since birth, it is likely a congenital weakness of your marginal mandibular nerve, often referred to as congenital unilateral lower lip paralysis (CULLP).  There are several treatment options.  The least invasive option would be botulinum toxin injection on the left (normal) side -  this would leave the left side depressing less and thus more symmetry of your smile.  This will wear off in 3-4 months so if it doesn't give you a result you desire, it will return to this state without any consequence.  There are also surgical techniques that can transfer muscle on the right side, bringing different muscle that does contract normally into the lower lip in an attempt to restore more normal function on the right.  These options carry greater risk and are obviously more invasive.  To determine the option best for you, I would see consultation from a board certified facial plastic or plastic surgeon that is well-versed in facial anatomy and may have experience treating patients with facial paralysis.Best wishes!

Joel Schlessinger, MD · Answer

Botox is a fantastic option for minor asymmetries of the chin area.  I love it for this indication, but it is really important to go to someone who is expert in this as it can easily go wrong and that would last for 3 months.  Look for a dermatologist who does their own injections and has quite a bit of experience.  I think you will have a good chance of improvement and save yourself time, expense and potential long term issues versus surgery.  That's why Botox is so amazing!  Good luck!

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