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Can Botox on Crows Feet Cause Muscle Paralysis in Other Areas of my Face?

I received 20 units of Botox on my eyes a month ago. For the first 10 days it was nice, no wrinkles. After about 10 days, I noticed pressure on my face when I smiled. I looked in the mirror to see that the left side of my mouth wasn't moving. It's a month later and now my smile just looks strange (crooked, moves abnormally). I look like a different person. I'm not sure if this is typical, and error on the part of the practitioner, or if it just doesn't work with my face. I'd appreciate a Dr's thoughts on this.

Asked 37 months ago by bg in san francisco

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crows feet paralysis side effects

Botox for crow's feet can migrate

It is possible that the injections you had for your crow's feet migrated a bit to the muscles in the upper face that control your smile. There are several issues that can affect this. We usually do not need 20 units for the crows feet. It is typically about 15 for our patients so it's possible a bit more than was necessary was injected. It could be that the placement of the product was not exactly where it should be and moved to affect other muscles in the area. Finally, it could be that... more

Doctor's Website

Harold J. Kaplan, MD

Los Angeles Facial Plastic Surgeon

Botox can cause unexpected muscles to be weakened if not properly placed.

Botox works well but it really is a toxin, and can not be made to wear off extra quick, so too much Botox or placement in the wrong area can really be a problem. Do not take injection lightly, even though it can seem easy when done by an experienced, board-certified dermatologist or plastic surgeon. It is possible that too much Botox was placed, or that it was placed in the wrong area, if you feel heaviness in your smile and in your cheeks when you were just trying to soften... more

Doctor's Website

Jessica J. Krant, MD, MPH

Manhattan Dermatologic Surgeon

Botox for crow's feet

First of all, you should only be injected by an experienced Board Certified Plastic Surgeon or Dermatologist. Second of all, injections for the crow's feet can be very effective, but your injector needs to be very careful not to inject too deep or with too much volume to prevent seeping of the Botox to the levator muscle for the lip. If this happens, it can affect your smile. The effect will go away, since Botox is never permanent, but may last for several weeks to... more

Doctor's Website

David Shafer, MD

New York Plastic Surgeon

ASPS

Not usually

When injected specifically in the muscles that cause the wrinkle being addressed, Botox should not affect unrelated muscles. It is curious that the other muscles did not become affected until 10 days after your Botox took effect. It is possible that you had diffusion or migration of some of the Botox on the left side so that the smile muscles on that side became relaxed. The only way to know if your "crooked smile" is related to the Botox is to see what happens after it wears off,... more

Anifat Balogun, MD

Seattle Facial Plastic Surgeon

Yes, but very uncommon

The peak effect of Botox is 1-2 weeks. 20 units of Botox is a typical dose for the crows feet, but it may be that you require less. Botox can diffuse 3 cm or greater from the point of injection so a low injection of the crows feet could very well have spread to the muscles that affect your smile, more on one side than the other. I suggest you be evaluated by the practitioner who performed your Botox injections to rule out other conditions unrelated to Botox such as Bell's Palsy (facial... more

Bryan K. Chen, MD

San Diego Dermatologist

Botox injections

It sounds like the Botox that was injected may have affected the muscles that allow you to smile as well. Usually when the crow's feet are treated it is unlikely for this to occur because the muscles that activate your smile is inferior and more medial to the muscles that cause crow's feet. Some injectors "chase" the crow's feet inferiorly and medially and the effect you have can occur. This usually wears off after 3-4 months. Steven Wallach, MD www.stevenwallachmd.com... more

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Botox on crows feet rarely spreads

After injection of Botox to the lateral eye area, a small amount of spread is expected. This is the approximately 1 inch in diameter. It is very unusual for Botox to spread beyond this area and affect other muscles of the face. If you are concerned, we visit with your surgeon can describe your concerns. It is important to determine whether this effect is from the Botox or from a mother neurological condition.