Use of a hyaluronic acid soft-tissue filler to correct congenital and post-traumatic lip asymmetry

The use of hyaluronic acid soft-tissue fillers for enhancement of lip features is a popular and minimally invasive office-based procedure used worldwide due to its relative simplicity and favorable safety profile.

A perfectly symmetrical face is a rarity in humans. Some degree of facial asymmetry is usually present in all individuals, even those with aesthetically attractive faces. In most cases, this asymmetry is barely perceptible and requires no treatment. However, even minor asymmetries can have a considerable psychosocial impact, and in such cases, their correction becomes valuable. This is particularly true with central asymmetry such as may be seen in the lip, an area that is most carefully scrutinized by many patients. The goal of the treating physician should be to strive for balance to achieve an aesthetically and psychologically optimal outcome.

The correction of lip asymmetries can be achieved with soft-tissue fillers; however, there is scant literature on this specific application. This report presents the management of a congenital and acquired volume deficiency of the upper and lower lips treated with a hyaluronic acid gel.

The past has seen a multitude of fillers, both temporary and permanent agents, used to fill lines, wrinkles, and lips. Expanded polytetrafluoroethylene, cadaveric implants, medical grade silicone, and other nonbiodegradable fillers have been used as “minimally invasive” techniques for lip augmentation, but most of these agents, after usually optimistic earlier reports, are prone to adverse effects such as deformities, nodules, and granulomas.

Although initially collagen products were widely used for facial lines and wrinkles and temporary lip augmentation, the requirement for frequent injections and the relatively high chance of allergy to these agents has led to their replacement by hyaluronic acid fillers. Hyaluronic acid is now the treatment of choice for these indications.

The data addressing the use of soft-tissue fillers in facial asymmetries are scarce, in particular for lips. Schweiger et al.reported the use of hyaluronic acid fillers for the correction of residual lip asymmetry in a patient after cleft lip surgery with favorable results. Further, there are reports of correction of asymmetric smiles with the use of botulinum toxin and an algorithmic approach discussing a standardized protocol for the management of lower lip asymmetry by botulinum toxin and/or surgery. However, the correction of lip asymmetries with soft-tissue fillers has not been discussed in detail in the past.

In these cases, needles were used to most accurately correct asymmetry as this is difficult to achieve with cannula. The injections were administered either by the syringe and needles supplied with the product or via decanting into 0.3-mL tuberculin syringes for more accurate implantation.

Fillers for soft-tissue augmentation are a popular procedure worldwide today for enhancement of facial features, but their use for the correction of lip asymmetries has been scarcely explored. In light of these results, we suggest that physicians consider this solution as an effective treatment for congenital, acquired, and postsurgical asymmetries.

Reference: Use of a hyaluronic acid soft-tissue filler to correct congenital and post-traumatic lip asymmetry
Kandhari Rajat, Goodman Gregory J, Signorini Massimo, Rahman Eqram