Advice? 13 months post masseter Botox & muscles still don't fully work

I'm really sorry to hear about the difficulties you've been experiencing. Here are some considerations and steps you might take to address the persistent issues you're facing after your Botox treatment:

1. **Assessment of Nerve Damage:**
- **Neurological Evaluation:** It's crucial to get a thorough neurological evaluation to assess any potential nerve damage. The symptoms you describe, such as muscle paralysis and facial droop, could suggest involvement of the facial nerve or its branches.
- **Electromyography (EMG):** This test can help assess the electrical activity of your facial muscles and nerves, providing insight into the extent of any nerve damage.

2. **Botox Complications:**
- **Spread of Toxin:** While Botox is generally safe, it can sometimes spread to adjacent areas and affect other muscles, which might explain the initial drooping and prolonged issues.
- **Injection Technique:** Incorrect injection technique or dosage might have contributed to the complications. Reviewing the procedure with the original treating physician or another specialist might provide more clarity.

3. **Prolonged Effects and Recovery:**
- **Individual Variation:** While most Botox effects wear off within 3-6 months, individual variation can occur. Prolonged effects beyond a year are uncommon but not impossible.
- **Physical Therapy:** Engaging in physical therapy with a specialist in facial rehabilitation might help improve muscle function and reduce compensatory muscle overuse.

4. **Potential Underlying Conditions:**
- **Underlying Neuromuscular Disorders:** Although rare, underlying neuromuscular conditions could be exacerbating your symptoms. A thorough workup by a neurologist might be necessary to rule out other conditions.
- **TMJ Disorders:** Persistent TMJ issues might also contribute to facial muscle dysfunction and pain. A TMJ specialist or maxillofacial surgeon could provide additional insights and treatment options.

5. **Aesthetic and Functional Concerns:**
- **Consultation with a Plastic Surgeon:** Given the mention of a facelift and concerns about facial aesthetics, consulting with a plastic surgeon or a facial reconstructive specialist might be beneficial. They can provide options for both functional and cosmetic rehabilitation.
- **Supportive Treatments:** Consider discussing supportive treatments such as facial massage, acupuncture, or other non-invasive therapies that might improve muscle function and reduce discomfort.

6. **Psychological Impact:**
- **Emotional and Psychological Support:** Dealing with prolonged facial dysfunction can be distressing. Seeking support from a mental health professional might help you cope with the emotional impact of your condition.

**Next Steps:**
1. Schedule an appointment with a neurologist for a comprehensive evaluation.
2. Consider a referral to a facial rehabilitation specialist for physical therapy.
3. Consult with a TMJ specialist and/or maxillofacial surgeon for additional insights.
4. Discuss aesthetic and functional concerns with a plastic or reconstructive surgeon.
5. Seek emotional support if needed.

Documenting your symptoms and their progression can also help healthcare providers better understand and manage your condition. Don’t hesitate to advocate for a multidisciplinary approach to address both the functional and aesthetic aspects of your situation.