Need to Fix Crooked Smile - Will Botox Work?

Question

I've had a crooked smile - I think since birth. I think that it may be a problem with the side of my face - rather than just the smile - let me know your thoughts. It's become a bit of a lifestyle problem - your input is very much appreciated. Will a botox injection work? The cost is around $500 for a 6 month result? Thank you,

Babak Azizzadeh, MD · Answer

Yes, Botox can be used to correct asymmetry or a crooked smile.  I would suggest going to a facial paralysis expert as we use Botox for this exact reason in many of our patients.

Ron Shelton, MD · Answer

It may be difficult to regain your neurologic function on the right side which is not lowering the lip with smiling. Botox used in a few units can be injected in the left side to minimize the muscle activity during smiling. this will make a more equaly smile but will less the amoun the lipos can open wide.

Harold J. Kaplan, MD · Answer

Hello CM.  Based on your pictures, when you smile the muscle below your mouth on the left side is pulling more so than the one on the right.  This is causing your smile to be asymmetrical.

While some Botox may help you, we have two suggestions given your estimate.  The first is that we do not believe it should cost as much as you mentioned.  Botox should last 3-4 months, but a very limited number of units would be required for this treatment.  If the practitioner has a minimum (say $250 per visit) then it's possible that the quote you are getting involves two visits (every thre emonths).  The other issue is that this type of treatment is very technique dependent and may require some trial and error to get the dosing correct.  In other words, it may be fiddicult to get your smile corrected exactly in the first visit.

Dev Wali, MD · Answer

If your problem is related to the nerve not working or the muscle not functioning then your crooked smile can possibly be treated with botox. Sometimes lidocaine can be used to mimic the effect of botox to test if muscle paralysis will work on your smile, this usually lasts a few hours. If it does work, then I would try botox for a longer lasting solution. You should see a board certified plastic surgeon for this, since they receive specialized training in dealing specifically with these kind of problems in the face.

Grigoriy Mashkevich, MD · Answer

You have an asymmetric depressor function. The easiest solution would be to inject Botox into your left depressor muscle. If you like how it works, this muscle can be sectioned to give you a permanent result. There are several physicians around the country who specialize in facial paralysis and facial movement disorders. In California, I'd recommend Babak Azzizadeh in LA. Good luck,

	Grigoriy Mashkevich, MD. New York Facial Plastic Surgeon.

Emily Altman, MD · Answer

Botox can help with facial asymmetry if it is caused by a greater function of muscles on one side of the face.  If the disorder is neurologic, it may be more difficult to improve.

	I recommend a consultation with a dermatologist or neurologist for a full evaluation of the problem.

Khaled El-Hoshy, MD · Answer

I believe a couple of Botox units on the left side of the chin PLACED CORRECTLY may offer you nthe needed correction. Definitely worth a try.

Jo Herzog, MD · Answer

It is difficult to see the asymmetry well in the photo but I can see some pull to the left side where your muscles might be stronger. I would go to someone with experience, either a dermatologist or a PS and see what they have to say. You can try a bit and luckily the results will only last a few months so there is no long term commitment needed. Go for it if it will make you happy or just keep your smile-it is you.

Michael Elam, MD (retired) · Answer

I would first suggest an evaluation with a good neurologist and see where that leads you. I am not sure of your exact location in California if you are in the southern California region or Newport Beach I would suggest seeing Phillip O'Carrol he is a renown neurologist who uses botox  in his practice for multitudes of nuerologic problems and would be a good start for consultation. Best regards!

Francis R. Palmer, III, MD (retired) · Answer

From your photo, it appears that your right lower lip is very weak compared to your left and the muscle is unable to pull your lower lip down on the right side compared to the left.  Before you have any treatment like Botox to weaken the left side, you should have an evaluation as to why you have unilateral facial nerve weakness to the marginal mandibular nerve on the right side. 

	 I'd suggest a consultation and examination with a neurologist first to rule out medical causes.  If it turns out that there are no medical issues causing this, you can then try some Botox in the left marrionette line to weaken the left side...this will however make your smile very flat as both sides, of the lower lip, will not depress down.  Not sure you want that look.  You may also ask the neurologist for strengthening exercises targeting the depressor muscles of the lower lip.

Need to Fix Crooked Smile - Will Botox Work?

Answers (12)