Asymmetrical Smile from Filler Injections on Nasolabial Folds

Question

I just had filler injected on my nasolobial area yesterday. Is it normal for my smile not to be symmetrical for the first few days? By non-symmetrical, I mean my left cheek is higher than my right when i smile. Will this eventually resolve on its own?

Otto Joseph Placik, MD · Answer

The Aysmmetry can be caused by several different factors:The injection techniqueThe filler's propertiesDepending on how much bruising/bleeding/swelling you experienced from the injection itself, this can affect or distort your smile. However, this should generally resolve withing one week. If the injection was directly into a muscle or nerve this can take longer but most fillers tend to resorb and you would see an improvement over timeDepending on the properties of the filler, you may observe several different results.For example is it a permanent or temporary/longterm filler?What is the chemical composition?What layer if the face is it recommended?Permanent fillers can have permanent effects and despite the obvious benefits, this is one of the reasons that doctors are reluctant to use them.Collagen products are mixed with an anesthetic that can make a muscle weak but this generally dissapates after 2-3 hours and should be injected more superficially. Evolence is a newer porcine collagen product which causes little bruising but can cause some firmness which may be felt but not necessarily visible. It also should be more superficial and not necessarily interfere with your smile unless alot was injected.Radiesse is a product composed of two primary materials, one of which takes about 3 months to absorb. This can cause some distortion which wil resolve at that point in time.Hyaluronic products (Restylane, Juvederm, Perlane, Hylaform, Captique, Prevelle, etc) are water attracting substances (hydrophilic) which can intially feel firm but generally soften over several days as they draw in water; think of a sponge soaking up water. If any of these have been injected in excess of your desires, they can be diminished using an enzyme hyaluronidase (skin test recommended).So it really depends.........I hope this helped

Raffy Karamanoukian, MD, FACS · Answer

There are two explanations for assymetry immediately after facial filler injections: These can occur from the numbing medication used or from localized swelling post injection. Both should resolve with time as there are very few, and rare, causes of permanent deformity.

David Shafer, MD, FACS · Answer

Hairbandrose,
You say you just had the injections yesterday.  Give it several days (sometimes up to 2 weeks) to completely settle.  This gives time for the swelling to resolve and the tissues to settle.
Most times, you will be surprised how nicely it resolves.  If there is still some asymmetry after that, it is usually just a matter of injecting a small amount on the smaller side to even it out.
Good luck.

Bernard Salameh, MD, FACS · Answer

Thank you for your question. In my opinion, it takes about 1-2 weeks for the product to settle down. First few day is still early to tell. Most of the times the asymmetry will improve by itself. Make sure to follow up with your surgeon as they can always perform touch up if needed.
I hope this helps. Best wishes. Dr. Salameh (Plastic surgeon - Bowling Green, KY)

Bryan K. Chen, MD · Answer

You may still be experiencing some inflammation, edema or fluid retention in one cheek more than the other, which can take several days to resolve. This kind of initial asymmetry is more likely to occur if your provider first injected local anesthetic into the nasolabial areas. You may also now be more aware of some pre-existing asymmetry, as most of us are not perfectly symmetrical when we smile. Nonetheless, after 2 weeks, your provider should be able to make any necessary adjustments as needed.

D.J. Verret, MD · Answer

After facial filler injections there can be a small amount of swelling which can produce some assymetries. Fortunately this will resolve but it can take up to a week or slightly longer. If things still don't look quite right after about a week, I would return to the physician who performed your injections and discuss it with them. At worst, if you had hyaluronic acid injections, you can inject hyaluronidase and dissolve the injection.

Hisham Seify, MD, PhD, FACS · Answer

One day following injection is still early. It usually takes several days for Hyaluronic acid based products to settle and get a final volume and appearance.
The good news is that mild asymmetry is treated by injection of more filler on one side. If more injections are not desired, the use of hyaluronidase enzyme helps to dissolve some of the filler volume.

Francisco Canales, MD · Answer

I would advise letting a week or two go by before making any judgements.  You could have swelling that is asymmetrical, swelling related to a nerve block you may have had or some bruising. There is no need to panic as most asymmetry problems resolve once the swelling has gone down.
If it persists, your surgeon can advise you of ways to correct the problem.  Your surgeon is personally invested in you having a good result so return to the office in about a week for reevaluation. Good luck in your recovery.

Steven Wallach, MD · Answer

It is not uncommon to have differential swelling.  It is also common for cheeks to be a bit different...that is normal.   If you still find it a problem then contact your doctor for follow-up.

Asymmetrical Smile from Filler Injections on Nasolabial Folds

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