Facial Asymmetry and Paralysis After Botox

Is it normal for one side of my face to be larger or fatter than the other after Botox and with smile paralysis four months after the injections? That side feels very heavy when I smile as well. How long can the smile paralysis last? Will my face ever be symmetrical again?

Read my review "One Side of My Face is Larger Than the Other After Botox Induced Smile Paralysis"

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9 Doctor Answers | Asked by ABCox in Portsmouth, Ohio

Doctor Answers (9)
Community Comments (0)

Botox doesn't change the size of your face

Botox can change the way your muscles movebut it shouldn't make one side of your face "larger or fatter" than the other. Perhaps your Botox hasn't worn off completely and you are feeling some residual effects. This should resolve soon.

You Weren't Symmetrical To Begin With

Symmetry does not exist in nature. Sorry, it just doesn't. Everyone's face is asymmetrical. You have a pretty smile and frankly I don't see any asymmetry with the smile. Next, why would you have your perioral or mouth region Botox-ed? Clearly you don't have the wrinkles around your mouth that is consistent with that treatment. So I would recommend not getting Botox again as you are unhappy with the results.

Botox and facial asymmetry

First, everyone has facial asymmetry. Botox will not cause one side of the face to be larger then the other unless you have had chronic paralysis over a 1-2 year period from repeated regular injections( like a patient who had a stroke when the muscle is not stimulated). On the other hand, injections around the mouth can affect your smile. This is the main reason why I do not like to do those injections. Fortunately, the Botox wears off in 4-6 months.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Recover from unwanted BOTOX facial paralysis is very emotionally disturbing.

Dear ABCox BOTOX is best from the eyes up. It can be used in the lower face but only with the utmost care. It is all too easy to get unwanted facial muscle paralysis. The face is one of the most important organs for emotional perception. There is evidence that the motor tone of the muscles of facial expression feedback into the emotion centers of the brain and influence how we feel. It appears that imbalanced BOTOX treatments can create an adverse emotional state. I have seen... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

The effect of BOTOX will completely dissipate in around 4 months after injection.

I read your question, and review. I'm sorry you had dissatisfaction with your last BOTOX treatment. Frankly, I do not see any significant "paralysis" or assymetry after your treatment. There may be less show of your upper gums when you smile, but your smile is not crooked or unattractive. If you post a full face frontal picture, I'll be happy to give you my thoughts. I have not seen the effects of BOTOX have any permanency, so your big smile will return shortly. Best regards.... more

Eric M. Joseph, MD

199 reviews

West Orange Facial Plastic Surgeon

www.ericmjoseph.com

Smile paralysis after botox

In your photographs it does not appear that you have smile paralysis. One side of the face can be fatter than the other because two sides are not identical. Botox should be on its way out. If you are able to move all your lip muscles, can speak, chew and swallow then you do not have to worry. If you feel your condition has become worst then see a neurologist. You still have a beautiful smile and your face appears symmetric. Regards

I can't see what you see!

I understand that your smile is important to your career so take what I say with a grain of salt. Botox typically lasts only 3-4 months on initial injection. If Botox caused what you call "smile paralysis" then it should be gone by now. The pictures you submitted are all at an angle, making objective commentary impossible. Your first picture already shows you with very thin lips to begin with. This did not change on the other pictures. he only thing that I see is that you can't... more

It should only take four months months to resolve

If the paralysis is due to Botox, it normally wears off in four months or so, just like the benefits of Botox do. It is highly unusual for this to happen after Botox. I would see an ENT doctor to be sure you do not have Bell's plasy.

If due to Botox, it may take 5 months to resolve

If the weakness is due to the Botox injection, it may take 5 months to completely resolve. There are other potential reasons for your weakness such as Bell's palsy which may need to be evaluated but that would be relatively unlikely. As always discuss this with your surgeon or injecting physician so that they may adquately assess you and provide you with recommendations.