Thank you for your question and for sharing your photograph hate. 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 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.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.If I had a patient with the concern described here I would recommend such laser skin tightening treatments on a weekly basis. The asymmetric smile will likely resolve slowly over a few weeks.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.
