How can I fix the asymmetry in my smile? (Photos)

Question

I have been trying to balance out my lips and smile for years now. In the past, I’ve gotten Botox to relax one side. I’ve also gotten lip filler and filler in my face. I’ve since gotten both dissolved in hopes to start over completely. Recently I’ve gotten Botox to try and relax my smile again but there’s been no progress. Is it possible to fix this with filler and in what areas? Is there a reason why my smile or face tends to lean towards one side? Should I no longer get Botox and filler to fix this? I’d love to get a better intentional opinion as I’ve spent thousands the past year and still struggle with unevenness.

Anna Chacon, MD, FAAD · Answer

First, I want to acknowledge how frustrating this must feel. When you've invested significant time, effort, and money trying to improve something and still feel dissatisfied with the result, it's completely understandable to feel discouraged.

One of the most important things I tell patients is that nearly everyone has some degree of facial asymmetry. In fact, a perfectly symmetrical face is extremely uncommon. The challenge is that once we become focused on an asymmetry, we tend to notice it more and more in photographs, videos, and mirrors.

Based on your description, it sounds like you've already tried many of the common approaches, including Botox, filler, and dissolving previous filler to start fresh. The fact that repeated Botox treatments have not significantly changed your smile may suggest that the asymmetry is not solely due to muscle activity.

A smile is influenced by multiple factors, including:

Natural differences in facial muscles from one side to the other
Underlying bone structure
Facial volume distribution
Dental alignment and bite
Nerve anatomy
Habitual facial expressions developed over many years

In some people, one side of the smile naturally elevates more strongly than the other. This is often simply how their facial muscles are wired and may not be fully correctable with injectables alone.

Regarding filler, it can sometimes improve asymmetry when there is a true volume deficiency on one side of the face. However, filler is not always the solution. In fact, repeatedly adding filler in an attempt to "chase symmetry" can sometimes create additional imbalance or an unnatural appearance. One of the most common mistakes I see is trying to correct a dynamic movement issue with a volume-enhancing product.

Similarly, Botox can be very effective when a specific muscle is overactive, but there are limits to how much muscle balance can be achieved without affecting natural facial expression.

What stands out most in your story is that you've undergone multiple treatments over the past year without achieving the improvement you hoped for. When that happens, it's often worth stepping back and reassessing the root cause rather than continuing to add more product.

The encouraging news is that your current decision to dissolve previous filler and evaluate things from a clean baseline was likely a very reasonable choice. Sometimes the most informative assessment occurs after prior treatments have settled and the natural anatomy can be appreciated again.

Ultimately, the goal should not be perfect symmetry—which is rarely attainable—but rather a balanced, natural, and expressive appearance. In many cases, the most successful outcomes come from subtle refinement rather than aggressive correction.

How can I fix the asymmetry in my smile? (Photos)

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