What to do now with lips? (Photo)

Question

I had lip filler in September of 2022. The filler did not settle properly and some has been dissolved since then, but my lips are uneven and I have a crooked smile. I just saw a plastic surgeon who added Hyaluronidase to the corner part of lips thinking it would even out my mouth but it hasn’t. Do I need more filler, more hyaluronidase or leave it alone? I’ve included a picture of how wide my smile was before lip filler and then almost a year after filler and currently.

Gary M. Horndeski, MD · Answer

You are a candidate for a lip lift. A lip lift does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Anna Chacon, MD, FAAD · Answer

I can suggest that you continue to communicate with your plastic surgeon or seek a second opinion from another qualified professional. They can examine your lips and provide personalized advice based on your specific situation.
Hyaluronidase is an enzyme used to dissolve hyaluronic acid-based fillers. If the filler was unevenly distributed or overfilled, hyaluronidase can help correct it. However, it may take a few days to see the full effect.
If hyaluronidase doesn't fully correct the issue, additional filler may be an option to balance out the lips. But this should be done cautiously and sparingly to avoid overcorrection.
In some cases, it may be best to let the filler fully dissolve naturally over time. This can take several months, but it would return your lips to their natural state.
Remember, it's important to consult with a medical professional who can assess your lips in person and guide you on the best course of action.

Corey S. Maas, MD · Answer

Unfortunately there is not a simple answer to your question. It will depend on how many times treated, presence or absence of scar tissue, and which filler was used&hellip;the last being most important. Depending upon what was used and where, most patients will be able to get this resolved without surgery. Based on your lip anatomy, a lip lift would be a much better and more suitable long term option after the visible filler and/or scar tissue is managed. is

Jeffrey H. Spiegel, MD · Answer

You may be having inflammation of a minor salivary gland in the lip at this point so hyaluronidase is not going to help. I would treat that by (1) placing a steroid injection (kenalog) and expecting improvement.  If that is not adequate we could try (2) removal of part of the gland. Both are straightforward in the office procedures.

Michael Contreras, MD · Answer

It appears that you may have had a neuromodulator (e.g. Botox, Dypsort) that is causing you upper lip position to be lower when smiling than it was in the first/pre-filler photo.  This can occur when injecting a neuromodulator near the nostrils for gummy smile.  As I don't think this is filler related, I don't think the "crooked" smile will improve with filler or hyaluronidase.  However, the lower lip is uneven in volume and could be addressed with focal hyauronidase to the left lower lip followed 1-2 weeks lateral by additional evenly placed filler into the entire lower lip depending on your preferences.

Anna Avaliani, MD · Answer

sorry to hear about your experience. On the photo included there is no visible unevenness so It's difficult to offer any input.
You either find a place that offers ultrasound assisted filler dissolverLeave them alonetry another consultation that will hand hold you through the dissolving processTry botox lip flip to see if you can even out the lip
Best,Dr.Anna Avaliani ,NYC

Leonard Grossman, MD · Answer

The asymmetry in your smile has nothing to do with the fillers that you have had in the past. Every single individual on this planet has some asymmetry in their mouth, as well as the rest of the face and body. Your smile is absolutely normal, and the only thing I would do, is to create more fullness in your upper lip for better proportions. If you look at your photographs from years before the initial treatment with the filler, you will find that your smile was always this way. This asymmetry cannot be corrected as it is based on the anatomy of your skeletal and muscle structures. I hope this helps a good luck from New York City Plastic Surgery .

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