Botox crooked smile and bulging neck muscle

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.

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.

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.

There are many physicians and nurses in our community who inject Botox or Dysport. Periodically a patient comes to see me with a concern of an asymmetry or a crooked eyebrow or smile following a treatment from a less experienced injector. One thing that is important to remember is that asymmetry is more often the norm and that a small amount of asymmetry can be an aesthetic draw. More often this asymmetry was evident before the treatment and may have been accentuated because the patient is now drawn to it once the animation has been muted. Even in the case of extreme asymmetry small doses are broken down more quickly and the undesirable visible changes are short lived.

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!

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. 

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.

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. 

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

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.