What treatment options do you recommend to patients with microstomia secondary to scleroderma?

Perioral and masseter botox 8U upper lip and 4U lower lip. 16U per masseter.

Perioral hyaluronidase can work great and without the potential of weakening the muscles. We do 200U diluted into a total of 6 mL (2 3mL syringes). Nerve blocks and topical 30% lidocaine for 20-30 min then inject in two lines on each cutaneous lip (one just above/blow vermilion border and one above/...