Uneven cupid's bow; how can I fix it? (Photos)

Question

Hi there--I've always had a very prominent Cupid's now in my upper lips, I've been noticing more and more lately that one side is almost pointed and seems less full as it goes to the corner of my mouth, while the other is nicely rounded and curves down in a pretty way to the other corner of my mouth. What is your opinion? Should I fix it--and how? I'm an actor/performer and I'm worried that I don't look attractive.

Ryan Mitchell, DO, FAOCO · Answer

Hello,

Thank you for your question.  You certainly do have a very well defined cupids bow.  That's not a bad variation of normal to have as is sets you apart from others.  Your lips are distinguishing and convey uniqueness.  As an actor/performer you are fortunate to have this interesting but not unattractive upper lip anatomy and may be memorable to your audience. With that said, you are concerned about the asymmetry of your cupids bow.  To begin, I am questioning if your lips are completely natural in these photos or if you have any filler that may be influencing your vermillion border and Cupid’s bow appearance? It appears to me that some filler is present in your upper lip and along the vermillion border (the outer edge of your lips).  If you do have filler in your lip, then the initial treatment would be to attempt to dissolve the filler if it is a hyaluronic acid type such as Juvederm or Restylane.  I have personally seen and created very similar asymmetry in the upper lip when using dermal fillers for lip enhancement.  This was caused from asymmetric injection technique through variations in needle depth and direction of product flow.  On the other hand, if your lips are natural in these photos and your asymmetry is native, then you have various options for improvement.  Take note that everybody has facial asymmetries between the left and right halves of the face.  Many times the only person that notices these minor variations is the very person criticizing his or her own face. With that said, first, you can do nothing and live with the imperfection.  Lip liner, lipstick and make-up should camouflage this asymmetry pretty well.  If that option is not acceptable then other options are available.  Keep in mind; every procedure or treatment comes with some inherent risk, no matter how small that risk may be.  There is a possibility that augmenting your upper lip may result in continued dissatisfaction or possibly an even worse result than the original issue.  I am not attempting to persuade you from not trying to improve your upper lip but simply informing you of the risks that go along with the journey.  Many times I tell my patients that the enemy of good is better.  Keep that in mind with every procedure you are considering.  In my opinion, the peaked side is the less attractive of the two.  If you insisted on augmenting your cupids bow area, I would work to soften the right side apex (peak) of the lip.  I believe that creating a softer, rounder vermillion Cupid’s bow apex zone to better match the left, will create a more pleasing and attractive upper lip.  Therefore, once again if you have filler in your top lip then your asymmetry is very likely caused by the filler injected asymmetric.  In that case, if hyaluronic acid filler were used, I would dissolve some of the filler on the peaked side and make adjustments accordingly.  If your lip is natural, minimally invasive options include using a filler to make your vermillion border and Cupid’s bow more symmetric.  Another option that may or may not work would be to inject a tiny amount of Botox directly into the peaked apex of the cupids bow on the right side.  1 or possibly 2 units targeted to the peak may relax the underlying muscle and cause a smoothing or rounding of the apex.  I am going out on a limb with that suggestion and I do not have a similar case to use as experience.  I am making an educated opinion about the Botox.  Finally, direct excision of the peaked apex of the bow on the right side will very likely result in a more rounded appearance.  With very careful removal of lip skin using magnification for excision and meticulous closure, you can likely achieve a more symmetric right bow apex as compared to the left.  There will be a faint scar as a trade-off but if you are resolute on creating a more symmetric balance to your upper lip, you may have to undergo a direct surgical procedure.  This can easily be performed in the office procedure room using nothing but a local anesthetic.  I hope you get your expectations met and I hope my lengthy response is helpful.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Placement of a hyaluronic acid dermal filler can help to restore volume and definition to the side of your lip that is less full.  This should help improve the subtle asymmetry between the right and left sides.  Be sure to see an ASPS board certified plastic surgeon in consultation to maximize your results.

Mohsen Tavoussi, MD, DO · Answer

Asymmetry of the lip is part of asymmetry of the face and body which is universal. Use of fillers in the lip line can improve the appearance of asymmetry.

Uneven cupid's bow; how can I fix it? (Photos)

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