Could Botox have caused this dent?

Hello,
As panel members suggested, it's very possible that the Botox migrated away from, or was not injected into, the correct location of the Masseter muscle. This in turn affects muscles in the neighboring area that control smiling and mouth movement.  As you mentioned, the effects of Botox does wear off over time which is what you are experiencing.
With regards to the "dent" that you are observing, we may only speculate that this may be an atrophy of the muscle mass as a result of the Botox treatment.  Regardless, it's important for you to have an in-person evaluation to determine cause and treatment options.  Using a dermal filler may be a good option for cosmetic benefit.

Dear Rupertfriend,without an examination it is hard to tell. It depends on the amount of Botox and area where it is injected but the effects usually last for 3-4 months. If you are concerned I would suggest you to consult your injector. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Botox or Dysport are great options for TMJ muscle pain in carefully selected patients. The injection technique is not overly complicated if the injector has a good understanding of the anatomy; however, this is an area that most people do not inject frequently.One of the concerns to be aware of is getting a crooked smile or asymmetric cheek movement.  This simply should not happen with a typical treatment, but it is a possibility.  It is due to the injection spreading beyond the target muscle (masseter muscles) and effecting some of the other muscles that are very close by that are involving in movement of the lips and smiling.In your specific case it is hard to guess what may have been going on without more details and an in-person examination.  Usually the effects of Botox or Dysport on the masseter muscles (or nearby muscles if they were inadvertently affected) would be gone by around 4 months or so.  Without more information I cannot begin to guess the reason for the area of a dent that you describe.

Thank you for your questions and I am sorry to read of your troubled experience. Botox typically wears off after 3-4 months depending on how much, where it was injected and if it were injected properly. It is difficult to say what the "dent" is or was caused by. An in-person consultation and examination with an experienced Board Certified injector would be a great first step. Hope this helps.Sincerely,Dr. Benjamin J. Cousins MD Board Certified Plastic Surgeon

I'm sorry to hear about your subpar experience as Botox for the jaw muscles is a very high satisfaction procedure. Based on your comments, it sounds as though the Botox wasn't injected properly. The good news is Botox wears off after 3-4 months so the results you're experiencing are temporary. The cause of the dent is hard to ascertain without a physical exam. You should definitely discuss this with your doctor.Don't trust your face to just anyone! As with all cosmetic procedures, you should see an expert in facial aesthetics to maximize results while minimizing side effects.