Facial Asymmetry and Paralysis After Botox

Question

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?

Jerome Edelstein, MD · Answer

Sorry to hear that you're not happy with your results. I suggest you see your injector for a follow up. By this time, the results should have diminished.

Kenneth D. Steinsapir, MD · Answer

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 individuals with "BOTOX Drift" with what appeared to be a minor smile weakness.  Yet they were so emotionally disabled that they could not work until the effect disappeared.  
The longevity of the effect will vary with the actual amount of BOTOX that was used.  However, as others have noted, it can take 3 to 6 months for these effects to resolve to the point where you are no longer self-conscious of your appearance.
Dr. Steinsapir

Eric M. Joseph, MD · Answer

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.

Tanveer Janjua, MD · Answer

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

Manish H. Shah, MD, FACS · Answer

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 bring the corners of your mouth up quite as high as before the Botox. I can't comment on asymmetry because your pictures are at an angle. 
You should go back to whatever level of symmetry or asymmetry you had before the Botox once its effects wear off. I would not focus on that area because the chances are that you are the only one that notices the difference. Also speak to a makeup expert as there may be a technique for makeup application that may camouflage your concerns temporarily until the Botox wears off.
Good Luck.

Facial Asymmetry and Paralysis After Botox

Answers (10)

Answer: Botox and facial asymmetry

Answer: Botox and facial asymmetry

Answer: Recover from unwanted BOTOX facial paralysis is very emotionally disturbing.

Answer: Recover from unwanted BOTOX facial paralysis is very emotionally disturbing.

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

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

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Facial Asymmetry and Paralysis After Botox

Answers (10)

Answer: Botox and facial asymmetry

Answer: Botox and facial asymmetry

Answer: Recover from unwanted BOTOX facial paralysis is very emotionally disturbing.

Answer: Recover from unwanted BOTOX facial paralysis is very emotionally disturbing.

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

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

Recommended reading

Everything you need to know about Botox

Answer: Smile paralysis after botox

Answer: Smile paralysis after botox

Answer: I can't see what you see!

Answer: I can't see what you see!

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