4 months after Botox in to turn up smile my face is still deformed. Any suggestions? (photos)

I am now worried the damage of the 2.5 units of botox snd 5 units along the jaw have permanently disfigured my face. My smile is still crooked and now my chin is pointy and pulls to one side. I am now past the 4 month mark and very frightened serious damage has bern done to my face vis this injector. Has anyone had a patient in which this did not resolve. The smile has slightly improved but the chin has not. I just want my fave back

Doctor Answers 10

Botox migration

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Unfortunately botox in the lower face can potentially migrate and cause these side effects.  The good news is botox cannot cause permanent damage like this and should improve soon.

Toronto Plastic Surgeon
4.9 out of 5 stars 518 reviews

Asymmetry after Botox

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Hello, and thanks for your question and photos. I'm sorry you did not get the result you had hoped for. I expect that this will likely continue to improve and eventually resolve over the next couple of months. I suggest following up with your physician. Best of luck, Dr. Frucht.   

Corey Frucht, MD, PhD
Santa Barbara Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Botox results

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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.

Abnormal smile remains 4 months after Botox

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If indeed this is all Botox related, it will reverse. It usually takes 4 months to resolve but some people it can take 5-6 months. I would continue to wait since there already is some improvement.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Botox and lip depressors

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Although the asymmetry is expected to improve within the next 4-6 weeks, you can consider injecting the lip depressors on the right side to balance the under-action on the left side. My advice would be to wait for a few more weeks. 

Costas Papageorgiou, MD, FACS
London Oculoplastic Surgeon

Asymmetric smile after Botox in the lower face

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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!


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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!

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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.

Derek Norcom, MD
Portland Physician

Botox and Asymmetrical Smile -- Will Resolve in 2-4 Months

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This will typically resolve in a short time, if you need a nerve specialist may be the best person to speak to at this time or your physician.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

4 months after Botox in to turn up smile my face is still deformed. Any suggestions?

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Hello nicolami6,Botox usually wears off by 4 months in most people.  I'm sorry to see that you are continuing to have the issues with your smile and chin after your previous treatment.  Since you have noticed some improvement, things will likely continue to improve.  You may also consider an in person evaluation to better assess what is going on.  This could be done with your original injector if it were a physician from one of the core aesthetic fields (facial plastic surgery, plastic surgery, dermatology).  If not, I'd recommend you consider seeing a facial plastic surgeon or plastic surgeon that perform his or her own injections.  I hope that helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.