4 months after Botox in to turn up smile my face is still deformed. Any suggestions? (photos)
Doctor Answers 10
Asymmetry after Botox
Sorry to hear about your experience with Botox. This is a known complication of Botox with probable spread of the Botox into the left DAO muscle. The good news is it is NOT permanent. Most patients, it takes 3-4 months to resolve but in some it can take longer. Be patient (I know it is hard), it will resolve. Good luck, try not to worry.
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Thank you for your question nicolami6. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. In the lower face Botox can be place in the mentalis muscle on the chin to address dimpling on the chin. It can also be placed along the jawline below the corners of the mouth into the DAO muscle to elevate the corners of the mouth. Between these two muscles lies the DLI muscle, which pulls down the lips. If Botox spreads to this muscle it can result in a temporary asymmetric smile. This resolves on its own in 3-4 months, but may take longer. Botox provides a temporary correction and all of the effects, intended and unintended, are temporary. Please follow up with your doctor for specific recommendations. Good luck!
The duration of Botox effects may vary from person to person. The reported duration in the product insert is 4 months, with other published reports up to 6 months. Nonetheless, the effects are not permanent. If injections are placed too deep nerves can be injured by the needle and result in neurapraxia (decreased nerve function). This is also temporary and resolves in 3-6 months. Migration of the toxin may also occur on occasions and have undesired effects.
If the picture on Lt is prior to injection, the Rt commissure (corner of mouth is higher), there is more showing of gum line on maxilla (upper jaw) and the Lt commissure is lower. The picture has rotation to the Lt and is difficult to evaluate lower lip position.
To lower the Rt commissure, the levator anguli oris can be injected and to lower the upper lip the levator labii superioris (Botox will decrease the action of the target muscle).
Based on the 1 month picture, the commissures are uneven with Rt higher than Lt, the Lt lower lip is elevated suggesting decreased function of the Lt depressor labii inferioris.
When comparing the 1 month and current picture, it seems that the Lt lower lip elevation is already improving (less elevation).
FDA has approved Botox for treatment of glabellar (forehead lines) and periorbital lines (craws) feet. All other sites are considered "off label" and doctors routinely advise patients regarding this distinction.
Asymmetries may occur even in the hands of experienced physicians. Always ensure that your physician has experience and training in understanding the underlying facial muscle anatomy and function.
Go back and see the injector!
The effect of Botox Cosmetic on the connection between the nerve and muscle can last as long as 6 months, sometimes longer. The intended effect is not permanent. It would be extraordinarily unlikely for you to have permanent nerve or muscle damage from Botox. The DAO (depressor angularis oris) muscle is very close to the depressor labii inferioris muscle, the muscle that pulls your lip down when smiling. The DAO muscle is the target for raising the mouth corners. From your photo, the depressor labii muscle has been affected, and this effect should be temporary. I would advise making an appointment to have an evaluation and discuss this with the injector.Google facial muscles and click on images to look at the anatomy and this will make more sense to you.