Januari 31, 2017
thank you for your question.you’ve submitted photos and you described in your question that you’ve had a crookedsmile since you were born. and you're asking if there is a way that botox or surgery canaddress this issue. well, i can certainly give you my perspective.i’m a board certified cosmetic surgeon, fellowship trained oculofacial plastic surgeon.and what you are describing just with the photos is something that, of course, for meit’s a diagnosis. i’ve been in practice for over 20 years. and the appearance youhave is actually something we watched for when we perform surgery such as facelifts.and so let’s start with the diagnosis that’s most likely just based on the photos alone.of course, in the absence of a physical examination,
there may be more issues that are also relatedthat happened neurologically at that time of birth or prior.so to begin with, what you have is a failure on the left side for the lip to come downwith smiling. now the reason is because of a particular muscle called the depressor angulioris muscle. this muscle is innervated or receives its signal to contract from a nervecalled the marginal mandibular nerve. now the relevance of this is that in situationswhere there is a trauma such as an actual accident or a surgical trauma that happensduring surgery such as face lifting surgery; or even from injectables, that nerve can developwhat’s called a neuropraxia, a temporary lack of activity which improves with time.and so initially, a lip can be up and then
– and that same muscle is actually withthe muscle that you used to show your lower teeth. and so, when – as time goes on, thenerve restores its function and then is able to innervate that muscle and the muscle contracts.but in a situation like yours where it is – it’s been there since birth, there isno expectation that there’s something can be done with the nerve itself. and the waypeople often will strategize, either to temporary neuropraxia surgery or even something likein your situation is to actually use a drug like botox on the opposite side.and as strange as that may sound where you’re purposely weakening a muscle to try to matchthe weak or – permanent paralysis or weakness of the muscle of the other side is that symmetryvery often is more desire than this obvious
asymmetry.so it might be worth considering. i certainly would not recommend any surgical procedurebecause i don’t think you would get a result that will be of value. there are differenttypes of surgeries that are used for people who have long – who have more profound facialnerve paralysis. but in your situation, remember, surgery can only do so much. but this is anact – this is an area that moves. and so when you correct to a certain point, it’snot likely that you're going to get a really great improvement in the overall symmetry.so what you can do is experiment with the use of botox with the opposite side or thecontralateral side is injected with botox in a way that relaxes the same muscle andsee how you like the improvement in symmetry.
it is something that is fairly low risk becausethe botox does wear off. and so within four to six months it can wear off or you can doa very, very low dose and just test it and see how you like it.so i think that the only option that would be worth considering is to do what i justrecommended – you know, recommend – you can consider is to see what happens when yourelax the other side and see what looks like when you smile; and that both corners go upand the lip comes up in the same way. you know, our brains are kind of wired toperceive both symmetry and asymmetry. so when it’s more of a symmetric appearance, theni think that the attention will be less drawn to the lip area. so i think that that’s– that may be a good strategy for you to
try.botox does require continuous maintenance so it may become a part of your lifestyleto do that. but otherwise i wouldn’t – i wouldn’t entertain the other possibly that’sin the surgical realm because i just don’t think you’ll get what you want, not at this– at this point of time. so i hope that was helpful. i wish you thebest of luck. and thank you for your question.
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