Lip Asymmetry Surgery
Q: Dr. Eppley, I am interested in lip asymmetry surgery. I have upper and lower lip asymmetry. I have had it as long as I can remember. It is present when I am not smiling and becomes more so when I do smile. What can be done for it?
A: Thank you for sending your lip asymmetry pictures and lip asymmetry surgery objectives. In the rest position I can see a left upper lip asymmetry with less very vermilion exposure and the lower lip looks just fine. In animation the left upper lip asymmetry becomes more noticeable and the lower develops an asymmetry the left side of the lower lip staying in the same position while the right lower lip gets pulled down. (which is normal) The lower lip acts like a marginal mandibular nerve paresis where the depressor muscle is not working.
The two things you can do are a left upper lip vermilion advancement to correct the upper lip asymmetry. This will provide improvements at both rest and in animation. Since you can’t bring depressor muscle movement back into the left lower lip side, the initial treatment should be Botox injections into the right lower lip depressor muscle to se how much correction of the lower lip occurs in animation. If successful and the Botox proves that weakening the normal depressor action of the lower lip is effective, one can move on to having a subtotal depressor muscle resections done for a permanent effect.
Dr. Barry Eppley