Botox to Fix Crooked Smile Goes Wrong

You have had several injections over varying periods of time. Therefore, Botox in each area has a certain lifespan. Even if you continue to try to balance the asymmetry, and can by some miracle achieve symmetry without further paralysis of the periorbital muscles, as each of the injections goes away, the asymmetry will return in a bizarre fashion.
We have seen your problem often. The best solution is to allow all the Botox to go away, then retreat with a top notch doctor. Also stick to one doctor who can know your facial expression intimately, including all its quirks and asymmetries, rather than go to several doctors. Your doctor should have an intimate knowledge of the anatomy of facial nerves and their target muscles. From your description there are several branches that have already been affected. The separate durations of action of each injection (3 months each) will just prolong your asymmetry problem as they go away.

We're sorry that you have had to experience a bad Botox outcome. Unfortunately, we think your best bet is to live with it as it is until the Botox wears off. Chasing perfect symmetry after several injections is a recipe for disappointment. Your second practitioner probably underdosed you the second time for fear of relaxing both sides and making it impossible to smile!
Our suggestion would be to wait a couple months until the Botox wears off and start from scratch with your original injector. The good news is that Botox wears off faster around the mouth than anywhere else on the face because of the constant movement. Good luck.

As all my colleagues have stated the good thing is that Botox is not permanent.
As stated, the best is to wait it out.
The alternative is to undergo more injection on the left to drop the lip which most people would consider undesireable but would give you symmetry. You risk having a weak smile with little movement. Another downside is that you risk having the weakness last beyond the time that the right returns. It is difficult to tell the time of your right sided injection but if that is over two months I would wait it out.
I know this is difficult for you to appreciate but injecting botox even by the same physician in the same area with the same dose can have differing effects each time you inject it. It is not too dissimilar to laying down an ink spot and predicting it will be the same each time. With botox the diffusion is even more complex because it is 3 dimensional.

Dr. Moelleken captures the real issue well.
While you may be able to get good symmetry with Botox injection on the other side the real problem is the staggering of the treatments.
Botox works by blocking acetylcholine release, causing a chemical denervation. Meaning that the muscle is paralyzed. Over time (4-6 months) that paralysis wears off.
If you get an injection now to balance out an injection you received a month previous you will likely have a period of symmetry followed by imbalance as the initial injection wears off.
You should wait for all the Botox to wear off.
I hope this helps.
Steven Williams, MD

Blindlee,
The bad news is that you may have to wait several months for the Botox to wear off. The good news is that Botox always wears off. In the mean time, you may be able to partially correct the asymmetry at rest by having a very small amount of Botox injected under the right side of your lower lip. The depressor muscle in this area pulls the corner of the lips down. So, if you inject the depressor muscle, you may see some improvement. However, with animation, only the left side of your face will continue to move until the Botox wears off. Good Luck.
David Shafer, MD
Shafer Plastic Surgery
New York City

Sometimes when you are in the middle of things that are not going right, it is best to quit before you get too far behind.  Worst case scenario, you will be back to normal in a few months.

The good news is that Botox is not permanent. The bad news is that it lasta 4-6 months. This is one reason why I do not like using it in the lower 1/3 of the face.  If too much is used, the patient looks like they had a stroke or a Bell's palsy.

Dear Blind,
You should seek out the physician that did your first treatment.  It sounds as if that physician is very skilled with Botox injections and may be able to offer some corrective treatments based on the facial movements that you presently have.  Good luck!

Hi.
My advice is try to do nothing for 3 months.  Then you are back to baseline, go see an experienced plastic surgeon.
If you absolutely cannot wait, I would give you 3 to 5 units of Botox in your left cheek.  No guarantees.