Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Levator Labii

Q. My smile is nice and wide and shows no gum. But when I am doing an eyes closed kind of huge laugh, either side of my lip would peak and show a little gum. Also when I smile I find it can pull my nose down a little and appears to bump on one side. Ive had the injections and HATE the result. I can’t smile properly at all, the gap between my nose and top lip now appears huge, and somehow thicker! I’m so upset. I know it eventually wears off (I hope) is there anything I can do to speed up the process? A. ​​So sorry for your troubles! Botox in this area is very technique driven. Just a unit or 2 of Botox just above the bone, lateral to the nasal pyriform opening will be enough to weaken the levator labii superiori alaeque nasi muscle and possibly diffuse laterally to the levator anguli oris muscles causing descent of a gummy smile. Too much Botox or too superficial an injection and other muscles such as the orbicularis oris, the nasalis and the depressor septi nasi muscles may also be weakened creating a disharmony of the area with the nasal bulging you describe. ​ ​There is not a lot you can do to reverse a Botox result you are not happy with as it takes the body about 3 months to develop the nerve end receptor sites required to regain muscle stimulation. ​ ​- I do believe that “mindful” or intentional exercising of the zygomaticus muscle may help stimulate return of function. Press the lip in against the teeth on the outer upper lip and attempt to lift the central lip upward 6 times a day for 5 to 10 seconds until you see improvement. ​ ​- Should there be further concern, there are “home” TENS-units which electrically stimulate muscle activity which I believe creates a positive feedback mechanism to accelerate return of nerve function. You may wish to consult with your injector or Board Certified Plastic Surgeon, ENT, Physical Medicine Physician or Physical Therapist for this option. ​ ​- A third option is a minute amount of filler along the upper “white roll” and philtrum to create the illusion of a up-turned lip. ​ ​I hope this is helpful! All the best!

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