Masseter Botox caused extreme tightness on one side of face

Question

When I smile, one side of my face feels extremely tight and my cheek has sunken in on this side. Underneath the eye scrunches and wrinkles. The smile line has also disappeared on this side and my smile is still weird. My face was perfect and symmetrical before this I’m gutted.

Anna Chacon, MD, FAAD · Answer

I'm sorry you're experiencing this. When someone is happy with their facial symmetry before treatment and then notices a sudden change afterward, it can be very upsetting.

From your description, it sounds like you've developed asymmetric muscle function after masseter Botox. The tightness you feel, the sunken appearance of one cheek, and the way the skin beneath your eye wrinkles differently when you smile all suggest that the muscles on one side of your face are not working the same way they were before treatment.

There are a few reasons this can happen:

One masseter muscle may have weakened more than the other. This can make one side of the lower face appear slimmer or more hollow.
Occasionally, the Botox can affect a nearby muscle involved in smiling if it diffuses beyond the intended treatment area. This can temporarily change the way your smile looks.
As the masseter relaxes, other facial muscles sometimes compensate differently, making certain folds or wrinkles seem more noticeable.

The encouraging news is that Botox is temporary. In the vast majority of cases, these changes gradually improve as the medication wears off, typically over 3–4 months, although complete recovery can occasionally take a bit longer depending on the dose used and your individual response.

I would avoid trying to "chase" the asymmetry with additional Botox right away, unless you're being evaluated by an experienced injector who can determine exactly which muscles are responsible. Sometimes adding more Botox too soon can make the imbalance worse rather than better.

If the sunken appearance is primarily from the masseter muscle shrinking, it's also important to know that the muscle gradually regains its volume once normal function returns. In many patients, this restores facial balance without any further treatment.

If your symptoms continue to worsen, or if you have significant weakness that affects eating, speaking, or closing your mouth comfortably, I would recommend being re-evaluated. Otherwise, observation is often the best approach because these effects generally resolve with time.

I know it's difficult when your face doesn't feel like your own, especially when the change happened after an elective treatment. Fortunately, the effects of Botox are not permanent, and most patients see their facial movement and symmetry return as the medication wears off. Patience can be challenging, but in situations like this, it is often the treatment that produces the best long-term outcome.

Dana Goldberg, MD · Answer

This result is not expected if only the masseter was injected. Photos would be helpful to be able to see what is going on, but luckily all effects of Botox resolve in 3-4 months, so this should not be permanent.

Shabnam Ghazizadeh, MD · Answer

Hi @Liz599807, I am sorry to hear about this. It is possible that the botox was inadvertently injected into one of the smile muscles. I am not sure how long ago the injection was Botox typically lasts 3-4 months. Best of luck, Dr. Ghazizadeh

Camille Cash, MD · Answer

What you are describing is not typical from a masseter Botox treatment.  I encourage you to return to your injector to discuss your concerns.  The effects of Botox are temporary and typically last three to four months, so the unwanted effects should gradually improve with time.

Masseter Botox caused extreme tightness on one side of face

Answers (4)

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