Botox to Fix Crooked Smile Goes Wrong

I had a very mildly crooked smile (right side rising higher than the other) which was not limited to my smile, but also when I talked. I was informed that a little bit of Botox could make this even and had success the first time so I got a second treatment (but with another doctor) while on travel. Since my right side was rising too much, the doctor decided to inject my side only. After 3 days I could see that there was too much injected on my right side, making my right side immobile. The left side seemed to over-compensate by moving much more than it used to, and also feels tired after talking even for a little bit. I returned to the doctor so that he could make the face somewhat symmetric by injecting a little to the left and he did so, but it has been over a week and no improvement can be seen. I have since left the country where I had it done, so I will have to search for another doctor. Looking at the appearance of my face, what would you recommend? Any advice that would help me get through the next 3 months would be helpful.

Tags:

smile crooked complication

Comment on this

9 Doctor Answers | Asked by blindlee in Korea

Doctor Answers (9)
Community Comments (1)

Time is your friend

Dr. Moelleken captures the real issue well. While you may be able to get good symmetry with Botox injection on the other side the real problem is the staggering of the treatments. Botox works by blocking acetylcholine release, causing a chemical denervation. Meaning that the muscle is paralyzed. Over time (4-6 months) that paralysis wears off. If you get an injection now to balance out an injection you received a month previous you will likely have a period of symmetry followed by... more

Find the Doc that did your first treatment

Dear Blind, You should seek out the physician that did your first treatment. It sounds as if that physician is very skilled with Botox injections and may be able to offer some corrective treatments based on the facial movements that you presently have. Good luck!

Do nothing for now

You have had several injections over varying periods of time. Therefore, Botox in each area has a certain lifespan. Even if you continue to try to balance the asymmetry, and can by some miracle achieve symmetry without further paralysis of the periorbital muscles, as each of the injections goes away, the asymmetry will return in a bizarre fashion. We have seen your problem often. The best solution is to allow all the Botox to go away, then retreat with a top notch doctor. Also stick to... more

The bright side is that Botox always goes away.

Blindlee, The bad news is that you may have to wait several months for the Botox to wear off. The good news is that Botox always wears off. In the mean time, you may be able to partially correct the asymmetry at rest by having a very small amount of Botox injected under the right side of your lower lip. The depressor muscle in this area pulls the corner of the lips down. So, if you inject the depressor muscle, you may see some improvement. However, with animation, only the left side of... more

A little Botox can fix crooked smile.

Hi. My advice is try to do nothing for 3 months. Then you are back to baseline, go see an experienced plastic surgeon. If you absolutely cannot wait, I would give you 3 to 5 units of Botox in your left cheek. No guarantees.

Botox for a crooked smile

We're sorry that you have had to experience a bad Botox outcome. Unfortunately, we think your best bet is to live with it as it is until the Botox wears off. Chasing perfect symmetry after several injections is a recipe for disappointment. Your second practitioner probably underdosed you the second time for fear of relaxing both sides and making it impossible to smile! Our suggestion would be to wait a couple months until the Botox wears off and start from scratch with your original... more

Harold J. Kaplan, MD

4 reviews

Los Angeles Facial Plastic Surgeon

www.celibre.com

Ride it out

Sometimes when you are in the middle of things that are not going right, it is best to quit before you get too far behind. Worst case scenario, you will be back to normal in a few months.

Botox

The good news is that Botox is not permanent. The bad news is that it lasta 4-6 months. This is one reason why I do not like using it in the lower 1/3 of the face. If too much is used, the patient looks like they had a stroke or a Bell's palsy.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Botox is not permanent

As all my colleagues have stated the good thing is that Botox is not permanent. As stated, the best is to wait it out. The alternative is to undergo more injection on the left to drop the lip which most people would consider undesireable but would give you symmetry. You risk having a weak smile with little movement. Another downside is that you risk having the weakness last beyond the time that the right returns. It is difficult to tell the time of your right sided injection but if that... more

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Doctors will not see your comments on their answers. If you'd like to follow up, please go here to ask another question.

Comments (1)

Lainey B. 16 Nov 2012

I had Botox around my mouth a year and a half ago to correct my slightly crooked smile. It changed my smile drastically in a negative way, and the effect lasted for three months. I just had to wait it out. The Plastic Surgeon that gave the injections (a decision that was made while I was in the chair getting one vial of lip filler) was very confident that the Botox would be an easy fix to my minor issue....and he did not discuss any negative possibilities. My lip filler turned out great...but I could not enjoy my slight lip plump because my smile looked like I was crying out in pain for about three months. Specifically, my lower lip did lower to show my bottom teeth when I smiled; so smile in the mirror while keeping you bottom teeth covered and you get the idea of my results. Oi. The Surgeon's response when I saw him five days later (when issue became apparent) was that it should go away in about a month because he'd used very little Botox to treat the issue. Again, I didn't look happy when I smiled for three months, and I would never have Botox or similar products injected in the lower portion of my face again. One must be very cautious with all injections. I’ve had very good and bad results with both Botox/Dysport and Restylane over the past two years- and I’ve always seen experienced doctors with excellent reputations. It is apparent from your photo that you are attractive with nice features and pretty skin. My experiences have taught me to not nit-pick my looks too much and to take better care of my skin and body overall, that is, to focus on prevention and preserving; such as, I now sleep on my back (which took determination and several pillows), I eat better and use sunscreen with antioxidants (physical block) every day.

Ask a Question