Does anyone know why my cheek is puffier than the other which is making my smile line realy deep? (photos)

I had Botox around 7-8 months ago and ever since Iv noticed one of my cheek on the right side sits lower than the other making my smile line really deep and more noticeable than the other, could this be because of the Botox but the Botox has worn off

Doctor Answers 9

Asymmetry of the Face

This is not related to Botox. No one is symmetrical. This can be taken care of with dermal fillers. Please make sure you see an expert injector. 


Summit Emergency Medicine Physician
5.0 out of 5 stars 23 reviews

Botox results

This is almost certainly not related to the Botox as the Botox has worn off 7-8 months after treatment. That being said, I do find that most patients take a closer look at their face after their first injection and notice asymmetries that they may have not known were their before their treatment. Almost everyone's face is asymmetric. The two sides of our face are siblings, not twins. That being said, fillers can be used to improve these asymmetries. 

Smile lines

We have not seen this following Botox injection.  Also, since the treatment was fairly long ago, the Botox would have worn off by now.

Dermal fillers would be the most commonly used approach for fixing these.

Reza Tirgari, MD
San Diego Physician

Asymmetrical Solutions with Facial fillers (Voluma, Radiesse, Perlane, Bellafill), implants or fat

This is unlikely the botox. I recommend getting a formal evaluation with a facial contouring expert. Facial fillers (Voluma, Radiesse, Perlane, Bellafill), implants or fat can be used to improve the symmetry of the face. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Asymmetry of face

This is not due to Botox. Looks like your natural dimples, which are not always symmetrical, and may be you never noticed it before. Would be good idea to compare similar pictures with expression, with your previous ones. No one is perfectly symmetrical except David of Michelangelo, as they say! I would be careful with fillers in this area, as you may not always get perfect results, due to so much movements and muscular activity in this area. 

Ram Chandra, MD
Edison Physician

Puffy cheeks

Your Botox has stopped being effective by this point and the differences in the "puffiness" of your cheeks is likely something that was there prior to your treatment. I would recommend that you speak with your physician and review your prior photos to see if fillers may be useful as you go forward.

Pamela Stuart, MD
San Jose Physician
5.0 out of 5 stars 2 reviews

Uneven facial features

The Botox is long gone and has no effect on this. No one is symmetrical and I think you started noticing this as you started getting procedures and paid more attention to it.  This can be treated with fillers if you so desire. Be sure you see a board certified dermatologist or plastic surgeon

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Asymmetric cheeks are normal

This is unrelated to Botox. This is just what makes everyone unique. Most faces are not symmetric and with all of our selfies, we are noticing things that we didn't prior. Fillers can help with symmetry if wanted.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Why is one cheek puffier than the other making smile line really deep?

Thank you for sharing your question and photograph.  I would review your before pictures with your injector to assess any inherent asymmetries and to have your cheek tissues evaluated to see how much swelling is present.  I agree that the Botox has worn off which should have returned you to your baseline appearance.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

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