Botox crooked smile and bulging neck muscle

8 days ago i was recommended botox for my chin to help it age at the same point as my forehead. 3 units were injected next to my chin on both sides and 6 units into my chin, it has caused me a pulling feeling a slightly crooked smile and when i smile wide a bulging of a muscle under one side of my chin like im lifting weights or straining, im a 27 year old fit person how long would 3 units typically take to wear off or ease up its unbearable and my injectore on holidays

Doctor Answers 11

Botox crooked smile

Botox in the right hands can produce a very nice effect in the lower parts of the face.  However with improper technique or migration of the botox it can cause undesirable side effects.  I would recommend discussing your results with your provider.


Toronto Plastic Surgeon
4.9 out of 5 stars 407 reviews

Botox injection and abnormal smile

Based on your description, it appears you have two issues:

1. The abnormal (crooked) smile is likely related to improper placement of the Botox or diffusion of the Botox into a muscle it was not meant to diffuse into. This may possibly be corrected by injecting the same muscle on the normal side of the face. 
2. The bulging muscle under the chin is likely related to inadequate injection of the mentalis muscle. Your injector will probably need to inject the part of the mentalis that is still moving. 

Botox usually takes 3-4 months to wear off. I would discuss your results with your injector. 

Smile problems after Botox

Properly placed Botox shouldn't cause any of these problem. I estimated that it will take at least 2 months to get improvement. You are right, duration is directly related to dosage. Lower face injections with Botox are more difficult and need to be done by an experienced injector. Probably your DLI was hit with the injection. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.5 out of 5 stars 22 reviews

Crooked smile and bulging neck after Botox

Thank you for your question jmhanen. Botox can be used to address the dimpling seen on the chin. The muscle that is relaxed is called the mentalis muscle. You have to be sure to use a small amount because there are neighboring muscles that need to be avoided. If the Botox reaches the nearby DLI (depressor labii inferioris) muscle it can lead to an asymmetric smile which lasts up to three to four months. If there is a bulge then the muscle that was intended to be treated may not have been treated completely. I recommend speaking with your doctor. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 1 review

Botox led to crooked smile

Thank you for your question about your Botox.
It will take, on average, 3 months for the effects of Botox to wear off.
If your injector was not a plastic surgeon, I suggest you see a plastic surgeon for your next treatment.
It sounds as though the Botox you were given has led to a temporary imbalance of the muscles of your face by being injected in the wrong areas.

Always consult a Board Certified Plastic Surgeon.
Best wishes. Elizabeth Morgan MD PHD FACS

Botox and Results

I suggest you consult with an expert as this is likely due to improper placement and will take 3-4 months to resolve on its own. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 150 reviews

Needs time

Botox takes full effect at about two weeks.
If there is asymmetry, it can be watched and followed or a little more botox can be injected into the side with more movement to even out the smile.

Botox and Uneven Results

This area where you had injected can be very tricky and it may now take up to three months for the effects to wear off.  Please consult an expert for the best cosmetic results.  Best, Dr. Green

Botox crooked smile and bulging neck muscle.

Thank you for your question and I am sorry to hear of your issues after Botox administration.  Depending on your appearance you may be a candidate for additional Botox to improve the symmetry in your appearance through paralysis of the bulging muscle, but if you are not interested wearing off of Botox often takes several weeks to a couple of months in a young active individual.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 35 reviews

Botox crooked smile and bulging neck muscle

Hello Jmhanen,

Sorry to hear about your result.  It takes about 3-4 months for Botox to wear off.  Since such a low dose was used you may notice a return of function before that.  I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.