Q: Dr. Eppley, I have an asymmetrical smile. When I was little I had a cross bite, I had an expander, braces, and retainers. My insecurity is that the sides of my mouth do not crease, or rise up the same. I can’t help but wonder if this is a result from the cross bite or vice versa. It makes my smile different on both sides and makes my mouth appear crooked. What is the procedure to correct this issue? How much does this average procedure cost? Thank you!
A: The asymmetry in your smile lines has nothing to do with your prior orthodontic history as your bite/teeth relationships have no impact on how the muscles of facial expression work. Your smile elevator muscles (zygomaticus and superior labii muscles) are working symmetrically as judged by the position of the corners of the mouth at maximal smile. (as seen in your picture) Your concern is actually that the depth of the nasolabial (cheek-lip) grooves are different when you smile. Your right side is much deeper than on your left. That is why your ‘smile’ looks different even though your actual smile (lip lines against the teeth) is actually the same. The attachments of the skin to the underlying tissues is what mainly creates the depth of the nasolabial fold in animation and that is a relationship that can not be reliably changed by surgery.
Dr. Barry Eppley