Botox cheek drop not getting better- I'm panicked (Photo)

Question

Dysport user for 5-6years every 3 months from PS. I had two doses within 7 weeks 12/1/23 and 1/25/24. Crows, forehead and 11. Last dose cheeks dropped and I couldn't smile for 2 months. Much less tight now but cheeks only lift to an indent. If I smile big my neck muscles buldge and my under eye pulls up. Two in person opinions said zyg mj and mi are weakened. My cheeks are so low. My PS doesn't know why I'm having prolonged weakness. No pain during injection & both sides.

Anna Chacon, MD, FAAD · Answer

It sounds like you’re experiencing prolonged muscle weakness and cheek drooping after Dysport injections, most likely from diffusion into the zygomaticus major and minor (ZMJ, ZMI) muscles, which are responsible for lifting the corners of your mouth and upper cheeks during smiling. This can result in a flattened smile, asymmetric or incomplete cheek lift, and abnormal recruitment of other muscles (like the platysma, causing neck bulging) when trying to smile or express.

Here’s what may be going on:
1. Muscle Over-Diffusion or Incorrect Placement
Dysport is known to diffuse more widely than Botox. If it’s injected too low or too laterally near the zygomatic muscles, it can accidentally weaken these smiling muscles, leading to the "cheek drop" effect. This typically resolves in 8–12 weeks, but in rare cases, the weakness can last longer, especially if compounded by multiple doses in close succession.

2. Cumulative Dosing Effect
Receiving two full Dysport treatments within 7 weeks may have contributed to the prolonged paralysis. These muscles didn’t have time to fully recover before being re-exposed, potentially deepening the suppression of movement.

3. Platysma Compensation
The platysmal band prominence and undereye pulling when smiling are signs of compensatory muscle activity. Your body is using other muscles to try and make up for the weakened smile muscles, which unfortunately can result in unnatural movement patterns.

What Can Be Done:
Time is still your greatest ally. Even with prolonged cases, muscle strength and facial expression typically return to baseline within 3–6 months.

Avoid further neurotoxin injections in or near the affected areas until full function returns.

Neuromuscular stimulation therapy or physical therapy (facial massage and facial exercises) may help facilitate recovery.

Hyaluronidase (off-label) in some cases is used to break down filler near the affected area if filler-induced pressure contributes to muscle compromise, although your issue sounds strictly toxin-related.

Final Thoughts:
What you're describing, the indent with smiling, platysma activation, and under-eye distortion, is consistent with zygomaticus paresis from unintended Dysport spread. It is not permanent, and while extremely distressing, there’s a high chance of full resolution with time.

Avoid future injections into the lower lateral orbicularis or malar areas, and make sure any future provider adjusts the technique to avoid this complication again.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. I'm sorry to hear that you're experiencing these issues with your Dysport treatments. Prolonged weakness and the feeling of a cheek drop can be concerning, especially after years of regular use. It's possible that the combination of doses you received within such a short timeframe may have contributed to this extended weakness in the muscles responsible for cheek support and movement.The effects of neuromodulators like Dysport and Botox can vary from person to person, and sometimes, the results can be unpredictable, particularly if there's been an adjustment in dosage or technique. In some cases, waiting for the effects to wear off can help, but if the weakness persists, other options like facial exercises, additional treatments, or even the use of fillers to restore volume may be worth considering. I hope this helps and best of luck!

Camille Cash, MD · Answer

The effects of dysport are temporary, typically lasting 3 to 4 months though they last longer for some patients.  If you are experiencing prolonged issues i encourage you to return to your injector and review your "before" photos to your current state to see if there has been improvement.

Kenneth D. Steinsapir, MD · Answer

During that time, you will have less volume and activity than normal. It takes time for these reconditioned muscles to build up tone and volume after this type of treatment. It is possible that some of the lost muscle volume from reconditioning the muscle could be permenant--we just don't know. It is widely believed that eventually the muscles and there associated volume will recover so my advise is to be patient and not accept any "permanent" fixes for this. That is a sure way to harm yourself. I would be curious about your past filler history because this can contribute to this type of situation. Also remember when you do eventually recover, you will be a year older and that can also be an issue.  There is no substitute for a detailed in person assessment.

Botox cheek drop not getting better- I'm panicked (Photo)

Answers (4)

Answer: It can take over a year for some of the minor muscle to fully recover.

Answer: It can take over a year for some of the minor muscle to fully recover.

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Botox cheek drop not getting better- I'm panicked (Photo)

Answers (4)

Answer: It can take over a year for some of the minor muscle to fully recover.

Answer: It can take over a year for some of the minor muscle to fully recover.

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.