I got botox around my mouth and it caused a crooked smile. Is there a way to fix this?

Suzanne,
Botox works by paralyzing muscles. This effect is beneficial in the forehead and around the eyes (crow's feet area) to reduce wrinkles caused by dynamic muscles. The muscles in your cheeks and around your mouth have very important functions in chewing and talking. While it is tempting to inject Botox in the upper lip and jowel area, it really serves no purpose. Most of the wrinkles in lip and around the mouth are static - that is, they are present even when the muscle is not contracting. These wrinkles require resurfacing to smooth them out or fillers from below to fill the defect. Now that you have had Botox injected around the mouth and you are suffering the dreaded temporary complication, the only way to help is to try and restore the balance of the muscles. This may be helped by injecting Botox on the other side to help restore symmetry or in an opposing muscle. In any case, you should talk about all of these issues with your doctor and make sure that only experienced people are injecting your Botox.
I hope this was helpful.
David Shafer, MD
Shafer Plastic Surgery
New York City

Sorry to hear about your experience with Botox. Fortunately, Botox is not permanent and you should be back to normal in a few months after your treatment. You may even see an improvement sooner. You could consider getting another Botox treatment to even out your smile.

Most likely, Botox will be able to help fix the problem you are encountering. We would suggest returning to your physician to show him/her the problem and get their thoughts on the situation. If the physician is very confident that he/she can fix the problem, then it may be worth letting them try. If they seem to be having second thoughts, it may make sense to look for an alternative practitioner for the corrective work or to wait several weeks to a couple months for the Botox to wear off (it wears off more quickly around the mouth because of the excessive movement).

Hi Suzanne,
I would return to the physician who treated you. After examining your peri-oral muscles and their movement, it would be possible to determine whether a small additional Botox would "even out" your smile. I'm sorry that you are having problems, but this again emphasizes the importance of having an experienced physician with knowledge of the underlying muscles performing Botox injections. This is a medical procedure. Be well and hopefully a quick recovery of your beautiful smile.
Dr. P

Thank you for your question suzanne_bernstein. 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 without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the orbicularis oris muscle around the lips to provide a pout to the lips and reduce the appearance of vertical lines around the lips sometimes called smoker’s lines (although they are seen in people who do not smoke as well). In this area 2-4 units are used above the upper lip and 2 units are used on the lower lip. Botox can be placed in the depressor anguli oris (DAO) muscle to elevate downturned corners of the mouth which sometimes produce a sad face appearance. In this area 2-4 units are used per side. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used. Botox can be placed in the levator labii superioris alequae nasii (LLSAN) muscle located just beside the nose on either side to address what is called the gummy smile. The gummy smile is seen in some people whose upper lip elevates so high when they smile that the upper gums are seen in addition to their upper teeth. In this area 2-4 units are used per side. Botox can be placed in a vestigial muscle (seen in some people) called the depressor septi nasii to prevent the tip of the nose from moving downward when smiling. Here only 1-2 units is required.In the lower face, the depressor labii inferioris (DLI) muscle sits between the mentalis and the depressor anguli oris (DAO) muscles. The DLI muscle is responsible for pulling down the lower lip and it is used when one smiles. If Botox spreads from either the DAO or mentalis to the DLI and relaxes the DLI it can lead to the appearance of an asymmetric smile. Some physicians try to correct it by placing Botox into the contralateral DLI muscle (on the other side). However, I recommend that my patients just wait as the effects go away on their own. 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.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!