I have a crooked smile after masseter/jawline Botox injection! What is it caused by and when will I recover? (photos)

Question

I have med/large bite muscles and received botox on my jawline. I first rcvd 30U of botox on each side of my cheeks. Two wks later, I rcvd 10U on the right and 15U on the left side of my cheeks. On day 4 after my 2nd inj, my smile became CROOKED! When I smile, the right side (rcvd 30+10U) have a weaker smile compared to my left. How often does this happen? Is it caused by inj area, amt of inj or inj technique? Did it hit a nerve or another muscle? When will I recover? What can I do to help it?

Jason Emer, MD · Answer

This can happen with Botox injection to any of the muscles around the mouth and jaw.  It will resolve over time, but please see your physician for evaluation and it can possible be fixed by balancing the other side.  I wish you the best, Dr. Emer.

Martin Jugenburg, MD · Answer

It does appear that your smile has been affected by the botox treatment in the masseter .  It is possible that some of the botox migrated toward the jaw and has affected the muscles that you use to smile.  It will take about 3-4 months for the botox to wear off and your smile to return to normal.  Best of luck

Harold J. Kaplan, MD · Answer

Hi Eve.  Yes, we do see that the right side of your smile (your right) is a little lower after the injection procedure.  This likely means that the injected product migrated from the masseter muscles to one of the muscles lower on the jawline that controls the lift of your smile.  This should improve over time as the product wears off.    To see an example of a masseter reduction for Orange County, CA patients without this side effect, check the link below.

Sheryl D. Clark, MD, FAAD · Answer

Sme of the Botox must have migrated to the zygomaticus major muscle.  The good news is, it is not terribly obvious and will go away.  Placement lower will likely avoid this in future.

F. Victor Rueckl, MD (in memoriam) · Answer

If your smile is uneven after Botox it either has to do with the number of units, or the point of injection, or more commonly, both. I would recommend an appointment with your injector. While this cannot be reversed (it will go away with time!), your injector should see it so he/she can be aware of what occurred specifically so it doesn't happen again in the future. "This answer has been solicited without seeing this patient and 
cannot be held as true medical advice, but only opinion. Seek in-person 
treatment with a trained medical professional for appropriate care."

I have a crooked smile after masseter/jawline Botox injection! What is it caused by and when will I recover? (photos)

Answers (5)