Asymmetry after LLSAN injection with botulinum toxin

Patient description

Female patient, 27 years old.

Patient’s complaint: the lip is being pulled to one side, even at rest. She is also concerned about a gummy smile.

Case description

Botulinum toxin therapy was performed in the forehead, glabellar region, periorbital area, nose, and for correction of a gummy smile.

On the 5th day after the procedure, the patient reported asymmetry of the smile and during nasal contraction. A corrective injection was administered, which resolved the smile asymmetry; however, the nasal asymmetry persists.

I would appreciate your advice on the optimal injection point for correction in this case.

Thank you for your expertise and recommendations.