Q: Dr. Eppley, I am looking to do something for my lower lip asymmetry. My bottom right lip pulls down. It is worse appearing when I smile. What type of lower lip symmetry surgery may solve my problem? Would a corner lift help this? I have had Botox injections, which definitely made it look better but I am seeking something more permanent.
A: Your lower lip asymmetry is caused by a weakness in the marginal mandibular nerve which works the anguli depressor muscle. (which pulls the lower lip down) This is why the left side of the lower lip is higher than the right which becomes magnified when you smile. You said that you were getting Botox to make it more even which I assume is done on below the right lip to weaken the depressor anguli muscle to better match that of the left side?
This leaves you with three options to improve your lower lip asymmetry:
1) Augmentation of the right lip vermilion to raise the lip edge
2) A partial depressor anguli muscle resection (done intraorally) to weaken the stronger right side so it elevates higher
3) left lower lip vermilion resection to lower the left
There are also combinations of any and all of these three.
Dr. Barry Eppley