Face Semi-paralyzed After Botox to Masseter Muscles? (photo)

I had 30 units of botox injected in the masseter muscles on the right side of my face; I leave the left side alone because the muscles aren't as active. I had had 25 units put in about 4 months ago, so this was not new. However, now the right side of my face is semi-paralyzed. My smile looks terrible because the corner of my mouth does not lift. I know there is no antidote to botox, but is there anything I can do to speed up the metabolization, help my smile, or strengthen the muscles? Thank you

Doctor Answers 8

Face Semi-paralyzed After Botox to Masseter Muscles?

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Yes your posted photo shows the effect of over injected BOTOX. Only time will correct, sorry. I recommend staged injections to this area due to the possibility of over treatment. I start with 10 to 15 units than wait 2 to 3 weeks for effect. Than inject 5 units each week til effect is satisfactory. 

Semi-Paralyzed Face After Botox Injections

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Unfortunately, there is nothing you can do to speed up the process. The reason this happened this time is not due to the amount injected, but the placement of the injection. Some of the Botox was placed a bit too far anteriorly, which relaxed some of the muscles of facial expression and not just the Masseter muscle. The good news is that since it is very likely that the great majority of the Botox was placed into the Masseter, a very small amount was placed into the muscles that are affecting your smile. My guess is that because we are talking about a small amount of Botox causing the problem, this should actually diminish rather quickly (maybe as quickly as 3 or 4 weeks). Hope this helps. Good luck.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

Botox facial paralysis

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Off label use of Botox is increasing.  The use in the masseter muscle is one example.  If  Botox is not precisely placed, it will do exactly what it was designed to do and paralyze muscles, only not in the right area.

The importance of knowing the anatomy is very great, especially when dealing with patients whose faces are in the public eye (i.e. newscasters).

The muscles that lift the lip are not far from the masseter muscle.

Hopefully in your case only a small amount of Botox percolated into the lip lifting muscles and the undesirable effects will be short lived.


Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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Face Semi-Paralyzed After Botox

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Unfortunately there's nothing you can do to make the Botox go away faster. The good thing is that your jaw muscle does move a lot more than other muscles, so in probably a few weeks, you should see this start to go away a bit. It won't take the whole four months for it to resolve, like poof!, one day it's just gone, but over the coming weeks you'll see that the muscle will begin to work again bit by bit and it won't be so drastic. Even though I'm sure you think it's just dreadful and noticeable, I would definitely say your picture really isn't that terrible or awful looking. Hang in there, it will get better.

Asymmetric smile after Botox to masseter

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I am sorry that you have a suboptimal result.  You are absolutely right that the Botox will wear off, with time.  There is nothing to speed up the process, unfortunately.  

The injection to the masseter probably affected the risorius.  This muscle pulls back on the corner of the mouth when you smile.  In general, I stay more posterior and inferior on the masseter muscle in order to avoid the risorius, as well as the zygomaticus.

No antidote for botox complication of big cheek treatment

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There may have been more of a superficial treatment to the levator muscles of the mouth rather than a deeper treatment to the masseter muscle.  It will resolve spontaneously with an expected full recovery.  There is nothing that can be done to hasten this recovery as far as I'm aware.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Face Semi-paralyzed After Botox to Masseter Muscles?

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 Aesthetically speaking you are seeing the effects of the Botox weakening other facial muscles thjat are used in animation.  A smaller does kept within the area of the Masseter muscle would be recommended in the future.  Until then, best not to have anymore Botox until this wears off.  Move the muscles, of the face, as often as possible as this encourages new neuromuscular junctions to form making the effects wear off more quickly.  Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Re-contouring Masseter Hypertrophy with Botox

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Re-contouring the jaw line with Botox has been utilized in Asian culture for years to Americanize the appearance of the face, and in fact, has been published in the medical literature.  However, this technique should not be trusted to a novice injector.  I have received beautiful results in my office with dosage far below the administered in this case.  Thankfully nothing is permanent and I would recommend choosing another injector.

Will Richardson, MD
Fort Lauderdale Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.