I like hyaluronic acid (juvederm ultra XC) for lip augmentation; I do not think it is better to do permanent first. I would try the juvederm first, and it will last 9-12 months. It should correct the indentation you are concerned about. Please consult a board certified dermatologist or plastic surgeon for optimal results. Best, Anita Gill MD
Thank you for your question, aim4perfection. Your options include the temporary procedures with fillers and the more permanent solutions with fat grafting injection. I suggest you consult with a board certified facial plastic surgeon to ensure you receive the highest quality knowledge, treatment, care and skill available.
Thank you for your photograph. I clearly see the indentation you describe in the right portion of your upper lip. From its appearance, it looks as though it would be easily amenable to improvement via the injection of a volumizing filler, such as Juvederm Ultra Plus XC, which I would use in my Upper East Side Manhattan practice or Princess Volume (my choice in my Israel satellite facility, where a far greater number of regulatory agency approved injectable volumizers are available). Hyaluronic acid fillers are natural and subject to the body's own natural metabolic, enzymatic processes, which I feel make them preferable to permanent fillers, which are entirely foreign to the body and have been associated with long-lasting, if not permanent problems, such as nodules and granulomas, which are difficult to treat. Radiesse, a semipermanent calcium-based filler is also not recommended for this region due to possible nodule formation.
Finally, I share your reservations regarding the use of fat grafting. In fact, I stopped performing it for any purpose over twenty years ago.
I strongly suggest you seek consultation and treatment by a board certified aesthetic physician with experience and training in lip augmentation, and not a practitioner accustomed and trained only to treat smile lines with ordinary fillers. Best of luck.
I suggest you first consider the fillers that will not be permanent, that way you can see what the potential result could be. I typically use Hyaluronic Acid products for the lips, either Juvederm or Belotero. If you are pleased with these fillers, down the way you may consider a more longer lasting treatment, such as dermal or fat graft.
I have found it possible to fix almost all lip asymmetries with a filler. Although you want a permanent solution, I have found that these "long lasting solutions" often bring their own problems and patients. Best, Dr. Green
Your asymmetry is only apparent when you smile, so correction must be done with great care because your lips are quite attractive when in repose. I recommend correction with a filler like Juvederm Ultra plus by an experienced injector very conservatively because over correction will cause another asymmetry. If you like the result, then you can consider fat transfer for a longer lasting result. Seek out a board certified plastic surgeon or dermatologist with lots of experience treating lips. Good luck!