Lower Lip Asymmetries

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When the lower branches of the facial nerve are affected, the muscles that depress the lip are paralyzed. This causes asymmetry, especially when attempting a large smile or when speaking. Patients will also often complain about biting the lip.


Often the simplest strategy is to paralyze the healthy side depressor muscles with Botox (botulinum toxin). This targeted-treatment approach paralyzes a very small group of muscles. The advantages of this approach include:

  • Minimally invasive
  • Reversible with time (usually three to four months)
  • May be repeated or converted to a more permanent solution

Surgery: Selective Muscle Removal, With or Without Nerve Removal

Removing the nerves that may be associated with abnormal facial motions (synkinesis) is often unsuccessful and may occasionally worsen the condition. Myectomy (removal of muscle) is usually more successful and often both the nerve and muscle groups may be removed.

Our specialists will usually try several Botox injections prior to performing surgery so patients have an idea of the targeted result.

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