Asymmetry of the mouth is not rare and consists of differences in the size and shape of the vermilion and/or the corner of the mouth. One side of the upper lip may be smaller than the other side or the corners of the mouth may be at different horizontal levels. Some patients affected by mouth asymmetry have had it since they were born while others have developed it with aging. Certain medical conditions that affect facial nerve function can also create mouth asymmetry with decreased muscular movement on one side.
The most effective method of improvement in mouth asymmetry, not caused by a nerve dysfunction, is a direct one. Moving the location of the vermilion-cutaneous junction through skin excision is the most visually effective technique. Lifting the skin from distant locations is not going to lift the mouth or improve lip symmetry. No form of a facelift or midface lift is going to affect the mouth area. This is well known in facelift where efforts to lift up drooping corners of the mouth is not successful.
Direct excision for improvements in mouth asymmetry are simple variants of the well known procedures of lip or vermilion advancements and corner of the mouth lifts. These direct excisional methods have been around for decades. Their effectiveness at cosmetic enhancements of the lip and mouth area can not be denied but they have never been widely popular due to the risk/concern of scarring.
For upper lip asymmetries a smaller side of the lip can be advance upward by a partial vermilion advancement that only goes as far as the cupid’s bow on that side of the lip. This can be combined with an extension into a corner of the mouth lift to create a complete elevation of the lower or hanging side of the mouth. While fine line scars are always a trade-off, they usually heal well when well executed even in high risk patients with intermediate pigment types. (e.g., Hispanics, Asians)
While not appropriate for everyone with mouth asymmetry, utilization of simple and direct procedures such as vermilion advancements and corner of the mouth lifts can be both effective and have acceptable scar lines.
Dr. Barry Eppley