Horribly Crooked Smile from Botox Nefertiti Lift

Question

I have this relatively new procedure called Botox Nefertiti Lift performed 12 days ago by a cosmetic physician, and it has lead to a crooked smile. A total of 20 Botox units were used along the jawlines. I have been unable to get a straight answer from the doctor. From looking at pictures, I think that the toxin has diffused into the Depressor Labii leading to the other side becoming hyperkinetic. I went back for a review and the doctor stated that she had hit  a muscle on what seems to me to be the unaffected (hyperkinetic) side and the remedy was to inject an opposing muscle on the jawline on the affected side. That was three days ago, if anything, the problem has intensified. I have read an article about the problem and the issue not being resolved by injecting the depressor Labii on the unaffected side. I am frightened and worried. How long will I have this crooked smile? What are my options for getting it fixed?

Brent Moelleken, MD · Answer

Botox is a wonderful drug.  It will do exactly what you tell it to do.
However, if you paralyze the wrong muscles with a direct injection, it will take three months to recover.
Any more Botox injections will undoubtedly prolong your agony.
The principle of the Nefertiti lift is that you can somehow get a cleaner neck by paralyzing muscles along the jawline.  It is not widely performed.

Harold J. Kaplan, MD · Answer

We agree with the general concensus of the panel members -- doing nothing is probably your best option. In some situations, the Botox effects will begin slowly wearing off before the 3-4 month mark which may allow for some gradual improvement. When a practitioner keeps trying to correct an unintended outcome, the unfortunate result is "chasing" the problem while creating potentially more problems. It's apparent that you are not satisfied with the information, feedback, and interaction that you've had thus far with your physician. Therefore, it doesn't seem worthwhile to return.

Raffy Karamanoukian, MD, FACS · Answer

In general, it is difficult for a consulting physician to determine the exact cause of a particular procedure, especially if it is newer and poorly described in the scientific literature.
The good news is that the procedure was non-surgical and likely related to Botox.  These clues would most likely direct a physician to conclude that the nerves are not irreversibly damaged and that the botox effects will eventually subside, thus restoring symmetry.
I would advise a patient in this condition to avoid correction at this time and allow the effects of botox to wear off.

Scott E. Kasden, MD, FACS · Answer

From what you describe, a nerve along the jaw (marginal mandibular nerve) sounds like it was hit by the Botox.  This will produce weakness in the lip depressors.  Fortunately, it will resolve over the next several months as the Botox wears off.
I am not familiar with the term cosmetic physician.

Steven Wallach, MD · Answer

Caveat Emptor! Beware of marketed named facial rejuvenation gimics. These are often done by people working at it as a true boutique type business and not as a medical practice. Remember everything we do can cause complications so it is important to go to a well qualified doctor. The botox will wear off in 3-4 months and the crooked smile should improve.

Horribly Crooked Smile from Botox Nefertiti Lift

Answers (8)