Crooked philtrum solution? (Photo)

Question

The depression line between my nose and upper lip is crooked. How can this be fixed? Furthermore my lips are a bit crooked, they look better when I shift them to the left a bit using my hand. Any help or advice?

Ronald J. Edelson, MD · Answer

Asymmetry of the columella is often due to steal cartilage that goes off to the side.  If that is the case, it is really a pretty simple fix.  If there are other factors, which can only be judged by exam, the correction may be more involved.

Juan Carlos Fuentes, MD · Answer

You have an asymmetry, with less volume on the right side of the face that creates the deviation on the philtrum and the lips. You can get it improved with a filler like Juvederm Volbella, on the lips and the corner of the mouth give you more balance on the area.

Clark Schierle, MD, PhD, FACS · Answer

You have to understand that there is no such thing as the “perfect” nose or philtrum. As rhinoplasty and facial aesthetic surgeons, we are able to improve the structure and function of the nose and face to address specific issues you have with how you look and and how well you can breathe. Perfect symmetry does not exist in nature. Attempts to improve the symmetry of your nose or philtrum should be aimed at achieving an improvement in your asymmetry to the point where it is no longer very noticeable. If you look carefully enough, you will always be able to find imperfections. The goal is a normal looking nose that is in harmony with the rest of your anatomy.

Marcelo Ghersi, MD · Answer

As far as I can tell this is non-pathologic facial asymmetry. In other words, your face is naturally uneven, not due to a disease process. "Fixing it" would be difficult and involve scars and surgery.

Sirius K. Yoo, MD · Answer

Thank you for your question and photo.  There are several potential causes including excessive muscle tone on the right side pulling the lip in that direction, diminished volume on the right side, and bony asymmetry (orthognathic asymmetries).  An in person physical exam would be necessary to differentiate.  The treatment for each condition is considerably different.  I would recommend seeing a facial expert who can examine you and make recommendations based on their findings.  If you have a significantly canted occlusion, it may be that you will need a referral to an oral surgeon who can discuss treatment.  All the best!

John Layke, DO, FACS · Answer

It appears from your photos that your philtral column is deviated to the right and that your right upper lip has less volume than the left.  I recommend meeting with a Board-Certified plastic surgeon who will examine you and offer an appropriate solution as an in-office consultation will provide you the most accurate results.  Best wishes!

Harry V. Wright, MD · Answer

The philtrum is the structure that you're indicating. I consider this finding, a slanted philtrum, to be strongly indicative of a dislocation of the nasal septum (the cartilage wall between your nostrils). I would expect to see the anterior septum dislocated into the left nostril. If that is the case it can be helped with surgery.Best wishes!  Harry V. Wright MD, Sarasota, Florida

Crooked philtrum solution? (Photo)

Answers (7)

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