Nerve damage due to Botox?? (photos)

Botox works on the terminal end of the motor nerve, where it stimulates
the muscle to contract. The junction between the motor nerve ending and the
striated muscle is referred to as the “neuromuscular junction”. With normal
muscle movement, a nerve impulse travels down the motor nerve and causes the
release of a chemical (the neurotransmitter, acetylcholine) from the end of the
nerve. This chemical travels across the neuromuscular junction, and stimulates
the muscle to contract. Botox paralyzes/relaxes muscles by blocking the release
of this chemical (acetylcholine) from the motor nerve ending; if the chemical
neurotransmitter is not released, the muscle does not contract.



Botox does not affect sensory nerves. The infraorbital nerve
is a sensory nerve, and is not affected by Botox. The infraorbital nerve
supplies sensation to the medial portion of the cheek, the upper lip, the side
of the nose, and the lower eyelid.



Zygomaticus major and zygomaticus minor muscles are
responsible for elevating the corner of the mouth / lip when you smile. The
weakness in your smile is related to Botox affecting the motor nerve function
to the zygomaticus major and minor muscles. Experienced Botox injectors know to
avoid this area, for the reasons you have experienced.



I am confused why your doctor chose to inject a local
anesthetic into this area as well. Most local anesthetics last only a few
hours, so I would suspect that your numbness has subsided. If your numbness has
not subsided, then further evaluation is warranted.



The effects of Botox are not permanent. The muscle weakness/
relaxation caused by Botox typically ranges from 3 to 6 months, with the
average relaxation being about 4 months duration. How long your weakness will last
depends upon how much Botox was injected into this area, and how much of the
muscle was affected. It is possible that after about a month you may start to
see some gradual improvements on a week to week basis. I suspect that by about
four months or so you should see relatively reasonable return of muscle
function.



My advice moving forward would be to find an experienced
Botox injector for your next treatment. Best wishes.

Unfortunately this happened but luckily the effects on the muscle will wear off in 3-4 months and you will have no permanent long term issue.  It is rare for the nerve to be damaged from needle injection into that area.  This is likely a result of poor injection technique.  Best, Dr. Emer.

The good news is that the effects of Botox are completely temporary, and you should start to see normalization of your smile around six weeks following your injection. Thank you for sharing.Dr. Joseph