Had Botox in my upper and lower lip 2 wks ago. My R lower lip droops and my smile is crooked. What can I do? (photo)

Hello and thank you for your question.  Botox will last you about 3 months, however, after a few weeks the intensity of it does let up a bit.  It may help to add a bit more to the side of the lower lip that is more active in order to balance them out.  Be sure that you are being treated by an experienced injector who specializes in facial aesthetics for best results!

There is probably not much you can do at this point as you are correct in that there is no reversal agent. The good news is that Botox is temporary and lasts about 3 months, which does not mean that your asymmetry will persist the entire 3 months duration. I strongly recommend you follow-up with our injector! Sometimes, the opposite side can be injected to create better symmetry but this is judged on a case-by-case basis.Best wishes,Thomas Walker, MD, FACS

Botox results last up to 3-4 months and can be softened with venus legacy and thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Botox lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox  essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. Follow up with your injector being that enough time has passed (2 weeks) to discuss your options and concerns. A little touch up should do the trick. Hope this helps.

I’m sorry you are experiencing a unfortunate result from Botox around the lip area. The good news is Botox is not permanent and likely will resolve sooner than 3 months due to typical low dose placement to the lip area. I would consult with your injector  (hopefully well experienced) to see if adding Botox to the left ( higher side) would be reasonable. 

I'm sorry you are having issues after your Botox treatment.  I recommend returning to your injector for an evaluation.  At two weeks the Botox is in full effect.  Unfortunately there is no reversal agent and it may make the situation worse if you inject more Botox.

Thank you for your question and for sharing your photograph Pghpetes. 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.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.In the lower face, the depressor labii inferioris (DLI) muscle sits between the mentalis and the depressor anguli oris (DAO) muscles and just below the orbicularis oris. The DLI muscle is responsible for pulling down the lower lip and it is used when one smiles. If Botox spreads from either the orbicularis oris, 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!

I’m sorry you are experiencing a unfortunate result from Botox around the lip area. The good news is Botox is not permanent and likely will resolve sooner than 3 months due to typical low dose placement to the lip area. I would consult with your injector  (hopefully well experienced) to see if adding Botox to the left ( higher side) would be reasonable. 

Injecting botox around the lips is an advanced technique as it can result in asymmetry of the smile. The good news is that it is not permanent and will wear off over time.  Usually a small dose of botox is injected into this area so hopefully it will wear off sooner than 3-4 months.  You should discuss with your injector whether you want to have the other side injected to even out your smile. 

Sorry to hear that you have ha negative effect from your Botox but it is a well recognized risk when injecting around the lips or chin.  While Botox does last about 3 months the muscles should begin to regain some function sooner than that and become more symmetric.   I recommend that you notify your provider and request a consultation to discuss your results.