Asymmetrical smile due to skin or fat over corner, what can I do? (Photos)

Question

Hello, I would like to fix my asymmetrical smile through surgery. There appears to be Skin or fat tissue growing over the corner of my mouth and it’s getting worse year-by-year. Also, on the same side there appears to be more fat or tissue around my lower cheek and jaw line. It’s really ruining my smile and I’m wondering what to do about the corner of my mouth?

Donald Groves, MD · Answer

Unfortunately, it is difficult to answer your questions without having a formal discussion with you of your specific surgical goals and a formal physical exam. Based on the history of this progressively growing "mass" by the corner of your mouth though, after performing a physical exam, I would refer you to get some soft tissue imaging to better evaluate that site- most likely with either an MRI or an ultrasound. Further management would be based on the results of the exam and imaging. The last thing you want to do is undergo an elective procedure (like a facelift, if indicated) without fully evaluating and addressing that "mass" to make sure nothing more serious is going on with it. I hope this helps! . Best, Dr. Donald Groves Plastic Surgeon

Ronald J. Edelson, MD · Answer

I would try to thin out the tissue there by going inside the mouth so there is no scar. Not sure if it would work but simple enough to try

Zoran Potparic, MD · Answer

Only on the basis of in-person evaluation an experienced surgeon would be able to find out whether this mass is a fat deposit, muscle hypertrophy, cyst or similar. Depending on the findings, mass can be removed using a small incision placed in the corner of the lips along the lip/skin line. Hope this helps.

Michael S. Kluska, DO · Answer

Facial asymmetry is common in everyone and becomes more apparent as we age and we lose facial fat due to atrophy. In your specific situation. the fat that covers the muscle is no longer as strong as it used to be, and as a result, what you were seeing there is the muscle, which has now skeletonized itself. options include facial fat grafting plus or minus the use of fillers and or Botox for treatment.

Andrew Kornstein, MD, FACS · Answer

Based on your photos(a video would be better) your asymmetric smile is due to a muscle bulge/hypertrophy.
The "why" may be more clear after an examnation of that side of your face esp since you note the lower cheek is more promnent on that side(may have descended)
I don't believe surgery is what you require instead a non surgical tightening of the oral muscles as well as the deep facelift(deep plane) layer to elevate tighten and rejuvenate that layer may be your best option
Hope this helps

Mats Hagstrom, MD (license on probation) · Answer

There are a lot of variables that contribute to facial contour. Developing Peri oral mounds, while smiling is not straightforward or easy situation to understand or treat.
Expect to get a lot of different explanations for what is causing this. As simplistic thought like this is excess, fat or excess skin is probably overly simplistic and a bit naïve. Often it’s a combination of connective tissue, dynamic forces of muscles of facial expression, potential skin laxity, or loss of skin elasticity, and a host of other soft, tissue variables.
While there are providers that claim to have successful treatment options for this condition, I think it is overall on the challenging side, and whether surgical intervention is indicated or not may be questionable.
Best,
Mats Hagstrom, MD

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