How to fix asymmetrical smile caused by Botox in masseter? (photo)

Question

I recently received Botox in my masseter muscles. Now my smile is asymmetrical. Is there anything I can do, any type of tool that can help to stimulate the muscle on one side?

Nima Shemirani, MD · Answer

Hi @anncard! Unfortunately, there is nothing you can do but wait. It will typically take 3-4 months for Botox to wear off. I hope this was helpful.

Martin Jugenburg, MD · Answer

Hi. Unfortunately there is no antidote for Botox. The effect will diminish gradually over the next 3-4 month.

Monika Soni, MD · Answer

Unfortunately, there isn't anything to do but wait.  Injecting alternate muscles may worsen the problem. The good news is that Botox wears off in 3 months and you will return to your beautiful self!

Michele S. Green, MD · Answer

It appears that your smile is asymmetrical because a nerve that affects your smile was affected.  It will take about four months for Botox to dissipate.  In the future please consult an expert in Botox for the best cosmetic results. Best, Dr. Green

Arianna Sholes-Douglas, MD · Answer

Thank you for your question!  Unfortunately, there isn't anything to do but wait.  Injecting alternate muscles may worsen the problem. The good news is that Botox wears off in 3 months and you will return to your beautiful self!

Vilma Di Maria, MBBS · Answer

Thankyou for your question. Unfortunately while injecting the masseters the injector hit one of the smile muscles.  You can not do anything about this now until the botox wears off. I wouldn't touch the other side as this could just make everything worse. I am not sure if you have spoken to the injector as i am sure he/she would like to know.It will resolve. Its just a matter of time. Good luck

Advanced Laser &amp; Skin Care Center - Alamo · Answer

Hello and thank you for your question. Botox can last up to 3 or 4 months. As each week passes, the effect it has on your muscles will diminish. It will just take some time to wear off as there is no way to reverse this. Your smile should return to normal with time.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph anncard. 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 knowing the dose used and the exact placement of the product. 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. There is anecdotal evidence that infrared light or radiofrequency treatments may speed up this resolution and I have tried this in the past.If I had a patient with the concern described here I would recommend trying such a treatment and being as patient as possible.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!

Leonard Grossman, MD · Answer

Technically you should not have a crooked smile after an administration of Botox for masseter muscle reduction,. However this has already happened and the only thing you can do at this point in time is simply wait it out for the effect of Botox to wear off which may take three to four months and in rare cases longer. Good luck from New York City

How to fix asymmetrical smile caused by Botox in masseter? (photo)

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