When will Botox fade?

Question

I got Botox injected into my masseter about a month ago and in my chin as well. I am no longer able to smile as big. I also got cheek fillers with Voluma and under eye fills with Volbella. What is causing my smile to be asymmetrical and funny looking? Is it due from the volume from my cheek fillers or the Botox ? And when will it go away ???

Monica Boen, MD · Answer

Thanks for your inquiry and I am sorry to hear you are not happy with the results of your injections. Without a photo, I can’t tell you exactly why you might be experiencing asymmetry around the mouth area. One thought is that the Botox could have been injected too close to one of the depressor muscles of your lip to cause an asymmetrical smile. I encourage you to make an appointment with a board-certified cosmetic dermatologist that specializes in injectable treatments for a full, in-person assessment and recommendations on how your current look can be improved. To answer your initial question, the effects of Botox usually last about three or four months, while the results of your fillers can last up to 18 months. I wish you all the best!

Jeffrey R. Raval, MD, FACS, MBA · Answer

Hello, I am sorry to hear you are experiencing this. Unfortunately, without an in-person consultation or photos, it is difficult to pinpoint exactly what is going on. But, it does sound like it might be your Botox. The timeframe Botox wears off within varies from person-to-person, but you should see the effects wear off after 3-4 months. Good luck!

Nirmal Nathan, MD · Answer

Dear realstargirl8,There are several muscles near the masseter that if they are affected (through either improper injection or diffusion of the Botox) will cause an asymmetric smile. If this phenomenon is the cause, it will thankfully go away when the Botox effect wears off. Make sure your injector is experienced and has a good understanding of anatomy. Plastic surgeons are uniquely suited to be expert injectors because of their in depth anatomical knowledge.Hope this helps,Nirmal R. Nathan, M.D.
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons

Kenneth Hughes, MD · Answer

Thank you for submitting you questions.Based on the information you shared I would say that the Botox would be the cause of the issues you are having with your face. Botox relaxes the muscle that is being treated and smooths out fine lines and wrinkles. For best results I would recommend you consult with a Board-certified plastic surgeon for optimal results. Best of luck.

Jason Emer, MD · Answer

Botox results last up to 3 to 4 months and can be softened with Venus Legacy and Thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Michele S. Green, MD · Answer

Without a photo it is impossible to say where the problem is in your treatment.  It is possible that too much fillers were injected in the wrong place or the Botox is causing the asymmetry. Please consult an expert in cosmetic injections for the best results. Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question realstargirl98. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Depending on the reason for the enlargement of the muscle, permanent results may be achieved. For example, some people have a habit of grinding, clenching, or biting their teeth subconsciously. Often times this happens in their sleep when they are not aware of it. Botox placed in this muscle will relax the muscle and the grinding, clenching, and/or biting will decrease. This will reduce the size of the muscle. If the brain gets accustomed to this and the person stops grinding, clenching, or biting, then the muscle will not become enlarged or as enlarged again. However, if the habit starts again, the muscle will likely get larger.
  
To determine if someone is a good candidate for this treatment it is necessary to look at a person’s lower face when biting and comparing it to when the person is not biting. If a bulge is seen on the outer portion of the jawline, then the person is likely a candidate. It can also be felt with the fingers when biting.
In the mid face, the risorius muscle and zygomaticus muscles sit near the masseter muscle which is treated for TMJ pain or to contour the lower face. When smiling, the risorius muscle pulls the corners of the mouth outward towards the ears and the zygomaticus muscles pull the corners of the mouth upward. The masseter muscle is used to bite down when eating. If Botox spreads from the masseter muscle forward toward the risorius muscle or upward toward the zygomaticus muscles, these muscles can also become relaxed, leading to the appearance of an asymmetric smile. This side effect resolves on its own in 2 weeks to 4 months, depending on the severity. Some find that laser skin tightening treatments using infrared light or radiofrequency may speed up the resolution process.
If I had a patient with the concern described here I would say that the asymmetric smile is likely secondary to the Botox treatment and I would recommend a series of laser skin tightening treatments to speed up the recovery. As mentioned above it could take anywhere from 2 weeks to 4 months for full resolution.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Selena Lantry, MD · Answer

While it is difficult to determine without an in-person consultation, based on your description I would say that the most likely cause of your asymmetrical smile would be the Botox.  The duration varies from patient to patient, but Botox usually lasts about 3-4 months.  I would recommend scheduling a follow-up with your provider to go over your results as you may be able to correct some of the problems with a touch up.

Scott C. Grevey, MD · Answer

Thank you for your question, 
Botox typically lasts 3-4 months. Depending on how much was injected and, how you metabolize it could be a bit  more or less. Be sure to discuss any issues with your injector. Choose a provider who has experience treating your areas of concern. 
Best,

Mohammed F. Ahmad, MD · Answer

Hello. Thank you for your question. The Botox in your chin is most likely what is affecting your smile. It usually takes about 3-4 months for the Botox to wear off. You may be able to add a little bit more to the affected side to help make it more symmetrical.

When will Botox fade?

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