Asymmetric smile with deeper nasolabial fold on one side – best treatment options? (Photo)

Question

I’ve had this asymmetry for as long as I can remember. One side of my smile is stronger, and the nasolabial fold on that side appears deeper, especially when I smile. I previously had filler in the pyriform fossa area, but it didn’t improve the asymmetry so I dissolved it. I recently underwent subcision (around 2–3 weeks ago), but I’m concerned it hasn’t significantly improved the fold yet. The asymmetry seems more noticeable with movement rather than at rest. I also previously had a crossbite corrected with Invisalign several years ago, so I’m wondering if jaw alignment or muscle compensation plays a role. My main goal is to achieve a more balanced, natural smile — not perfection, just less noticeable asymmetry. I’d like to understand: • Whether this is primarily muscle-driven vs structural • If Botox could help reduce the stronger side • Whether filler (and where – e.g. nasolabial vs pyriform vs cheek) would be effective • Whether fat transfer would be more appropriate than filler in my case I’d really appreciate guidance on the most effective approach.

Anna Chacon, MD, FAAD · Answer

hat you’re describing is actually very common—and you’re also noticing the right detail: it’s more visible when you move, not so much at rest. That’s an important clue.

When asymmetry shows up mainly with smiling, it’s usually not just “one fold being deeper.” It’s almost always a mix of muscle strength + facial structure + how your tissues are being pulled during expression.

Is this muscle or structure?

From your description, this sounds mostly muscle-driven with a structural component underneath.

One side of your smile is stronger → that side’s muscles are likely pulling harder
The fold deepens more on movement → that’s dynamic tension, not just volume loss
Prior orthodontic correction can absolutely shift subtle facial balance, even years later

So yes—jaw alignment and compensation patterns can play a role, but at this point it’s usually more about how your facial muscles learned to move over time, not a fixed jaw problem.

Why filler didn’t fix it

This is actually a key point.

Filler in the pyriform area often doesn’t correct asymmetry when the issue is movement-based. It can soften static folds, but if one side is still pulling harder, the difference will still show when you smile.

That’s likely why you didn’t see much change—and dissolving it was reasonable.

What about subcision?

At 2–3 weeks, it’s still very early. Subcision results are not immediate—collagen remodeling takes time, often 2–3 months or longer. So I wouldn’t judge that yet.

Would Botox help?

Yes—but only if it’s done very strategically.

In cases like yours, Botox can be used to:

Slightly soften the stronger pulling side
Reduce the asymmetry in smile dynamics
Improve balance without freezing your expression

The key is micro-adjustment, not heavy treatment. Overdoing it can flatten one side of your smile, which would feel worse than the original issue.

Where filler actually helps (if used at all)

If I were considering filler here, I would not start in the fold itself.

Instead, I’d look at:

Midface/cheek support first (very subtle, if needed)
Possibly small pyriform support only if there’s true deficiency
Avoid directly chasing the nasolabial fold, especially in dynamic asymmetry
What about fat transfer?

Fat transfer can be helpful in some cases, but I would not consider it first-line for this type of issue.

Why?

It’s less precise for asymmetry
It’s harder to fine-tune side-to-side balance
And your issue is more movement-based, not pure volume loss
My honest clinical perspective

Your goal isn’t to erase the fold—it’s to balance how your face moves when you smile.

In patients like you, the best results usually come from:

Light, targeted Botox to balance muscle strength
Conservative structural support only if needed
And patience after subcision, since you’re still early in healing

If done correctly, the goal is not symmetry that looks “corrected,” but a smile that feels more even and natural—without you noticing one side pulling ahead of the other.

That’s absolutely achievable—but it requires a very conservative, step-by-step approach rather than trying to fix everything at once.

Asymmetric smile with deeper nasolabial fold on one side – best treatment options? (Photo)

Answers (1)

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