Will Botox help my uneven, puffy smile? (Photo)

Question

I’m 28 and have had masseter Botox a couple times a few years ago. When I smile I feel ugly, my thin lips disappear, my face gets weird lines, my cheeks and eyes look puffy, and my jaw looks wide and uneven. I want to find a solution that’s non surgical or has no downtime, but I don’t know if Botox is the answer, and I’m scared of filler. How can I achieve a more beautiful, feminine smile?

Danielle Shanley, MD · Answer

Thank you for sharing your photos! Based on what you described, I wouldn’t recommend assuming Botox is the answer for everything. Masseter Botox could help slim your jaw if the width is coming from the muscle, but it won’t address your lips, puffiness, or all of the lines you notice when smiling. Subtle lip filler could help with your lips disappearing when you smile, but filler may not be the best choice if you already feel your cheeks or under-eyes look puffy. Since several different things are bothering you, the best next step is to see an experienced provider who can look at your face at rest and in motion and explain all of your non-surgical options before you decide on anything.

Anna Chacon, MD, FAAD · Answer

I can understand why you’re looking for a solution that doesn’t involve surgery or filler. When the changes are most noticeable when you smile, it can be especially frustrating because your face may look completely different at rest.

The first thing I would point out is that there probably isn’t one single issue causing everything you’re describing. A wider or uneven jaw, cheek fullness, disappearing lips, and changes in the lines around the mouth can involve several different muscles and soft-tissue structures.

Could Botox help?

Potentially, yes—but I would not automatically recommend more masseter Botox based on these symptoms alone.

Masseter Botox works by temporarily reducing the size and activity of the masseter muscle, so it can make a broad or square lower face appear slimmer. It can also help when asymmetry is genuinely caused by one masseter being more prominent than the other.

However, the masseter is close to muscles involved in smiling. If Botox spreads beyond the intended muscle or is placed too high, it can occasionally cause smile asymmetry, reduced smile width, or an unnatural smile.

That is particularly relevant in your case because you're already noticing that your smile looks uneven and that your lips seem to disappear when you smile.

What about the puffy cheeks and eyes?

I would be careful about trying to treat cheek fullness with Botox. Botox isn't really a treatment for facial fat or generalized cheek puffiness. If the fullness you're seeing is related to muscle movement, Botox may help in a very targeted situation, but if it's related to your natural fat distribution, anatomy, or the way your cheek moves when you smile, reducing muscle activity may not give you the result you're hoping for.

And sometimes, making the lower face smaller isn't necessarily the same thing as making the face more feminine or balanced. Over-reducing the masseter can potentially make the cheeks or lower face appear less supported and, in some people, can create a more hollow or aged appearance.

I would focus on the smile mechanics first

Before injecting anything, I would want to watch your face at rest, with a gentle smile, and with a full smile.

The important questions are:

Is one masseter actually larger than the other?
Does one side of the mouth pull differently?
Are the cheek muscles contributing to the asymmetry?
Is the lower lip being pulled down more strongly on one side?
Is the chin contributing to the uneven appearance?
Are the lines you're seeing caused by muscle contraction or by the underlying shape of your face?

Botulinum toxin can be used very selectively to address certain forms of facial asymmetry, but the key is identifying which muscle is actually responsible before weakening it.

And I wouldn't rush into filler

It's completely reasonable that you're hesitant about filler. You don't necessarily need filler simply because your lips look thinner or disappear somewhat when you smile.

At 28, I would generally favor preserving your natural facial movement and making the smallest possible adjustment rather than trying to completely reshape your face.

If Botox is appropriate, a conservative and highly targeted approach may be more appropriate than repeating the same masseter treatment you had previously. And because your concern is specifically your smile, I would be particularly cautious about treating the muscles around the mouth without first understanding exactly what's creating the asymmetry.

Ultimately, the goal shouldn't be to make your face as narrow or as "feminine" as possible. It should be to preserve your natural expression while improving the balance of your features. A beautiful smile is one that still looks like you when you laugh and move—not one that has been overly frozen or sculpted.

Camille Cash, MD · Answer

From the description of your concerns you may have the best result from a combination of treatments.  Botox to the masseter muscle can help slim the jawline.  Fillers can be used in the lips to add conservative volume and highlight shape.  Fillers in the lips do not have to result in an overinflated look!  When done by an expert injector you can expect a natural enhancement to the lips.

Nuket Eroglu, MD · Answer

Hello; You have very beautiful and big eyes; but you have thin lips that do not match with them. For 28 years old young girl, eye and lip sizes should be close to each other. Due to this, I recommend for you getting fillers on your lips for both volume and contour. My preference is Maili. It's very fluid. It does not leave any nodules. It remains intact for a year. That's why, Maili which is a superior technological product of Oxygen-Free technology; will give both shape and volume to your lips. You have prognathia problem in your jaw. So, especially when you smile, your chin becomes more forward. The upper lip lags behind and disappears. This may disturb you while laughing. You can partially prevent from this with lip filling. Having your lower lip slightly forward, especially from the side, will give you a natural and beautiful smile. I advise for you AquaShine to give face lift, moisture and shine. This product, consists of uncross-linked Hyaluronic Acid and skin revitalizing vitamins,minerals and they will make you very happy.

Will Botox help my uneven, puffy smile? (Photo)

Answers (4)

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