My smile is crooked. What's causing it and how do I fix it? (photos)

One side of my top lip is staying and the other side moved up and shows my gums...

Doctor Answers 2

Crooked smile.

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Hi Sofie. Your lips are beautiful, and your teeth look like they will be, so that's a pretty good deal for a beautiful young woman.

Yup, your smile is a bit crooked, and it appears as if there is slight weakness not only in the left upper lip, but more so in the depressors of the left lower lip. I would want to see how your face animates, and would also want to ask you if this has always been this way, or if it is recent.

Assuming that your lip has always looked this way when you smile, it is congenital facial nerve weakness in the marginal mandibular branch and possibly one of the buccal branches on the left side of your face. Microsurgical cross-face nerve grafts have been done (Dr. Julia Terzis has done pioneering work in congenital and post-traumatic nerve palsy patients), but this is big-deal surgery done most commonly for complete paralysis patients, not partial and minimal as your appears to be.

I think asymmetry like this is not unatrractive at all and should not be considered a problem, especially since the "cure" is WAY worse than the problem. Be peaceful about this--this does not make you ugly or weird-looking, just someone with a unique smile! Botox can weaken the other side, but I'd not recommend weakening normal function to (try to) match slightly decreased function. Best wishes! Dr. Tholen


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Sofie: Thanks for your question.  If your smile has been like this from early childhood, it is likely a congenital issue (acquired during development) called "congenital unilateral lower lip palsy."  This can just happen, or can be due to trauma to the nerves and/or muscles that pull down on the lip during birth.  If is more recent, it could be due to trauma to the chin/upper neck on the left side.  Finally, if you've ever had bell's palsy (facial weakness) this can be a sequelae of that as well.

You look young, but botox can be injected into the muscles on the right side so they don't pull down as much, which will make your smile a little more symmetric.  Best of luck. 

Garrett Griffin, MD
Minneapolis Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

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