How To Avoid A Joker Smile After Fillers?

I tell my patients that there are basically two lip fill styles: Executive lips and adult entertainment lips.  It is important that the doctor not confuse these two styles.  Too much fill as you have discerned looks ridiculous.  Honestly even my patients who are in the adult entertainment business don't want this look.  It is typified by overfill of the upper lip so that this lip is disproportionate to the lower lip.  The lower lip should always be stronger than the upper lip.  Additionally, each lip will only hold a certain amount of volume before the anatomic details of that lip are blown out.  That loss of anatomic detail makes the lip look cartoonish.  Lip fill like any facial fill is an art form.  It is not a commodity service.  Unfortunately you often get what you pay for.  Don't assume that every injector is Michelangelo di Lodovico Buonarroti Simoni.  Don't assume that your injector understands what you are looking for.  If the lips on the doctor's receptionist look goofy that is a sure test that you are in the wrong place.  Tell the receptionist you were just paged by work for an emergency and have to go.  Find a different office.

This usually is the result when seeing an unexperienced injector or having to much product injected. Seek a reputable certified physician to get an honest evaluation and can provide the best, natural, and conservative result

A joker look is not a usual outcome. If the injector is skilled, this shouldn't occur. This can also occur if the DAO muscle is over injected with Botox and this is probably more likely the culprit. The aging mouth often has drooping of the corners and I will frequently try to lift these with the injection. If the corners are already lift, I suppose that the lips could be overcorrected if the corners are injected. 

The Joker Smile is the sign of an inexperienced injector.  As a physician gains knowledge and critically evaluates their results, they avoid the tell tale signs of filler placement.  Stay with a physician who's main career is aesthetic medicine and avoid the fly-by-night spas.  You will happy that you did.

In my opinion, the best way to avoid a bad appearance following soft-tissue fillers is to have the treatment performed by a board-certified dermatologist or plastic surgeon who has extensive experience in the use of soft-tissue fillers (e.g. Juvederm and Restylane) and neurotoxins (e.g. Botox and Dysport). Communicate with the doctor what you would like to improve upon and communicate what you want to avoid. I think that people get in trouble when too much product or products are used. Some people might utilize Botox or Dysport to treat the depressed corners of the mouth. This helps to relax the depression of the corners that some people have. Then a filler can be used soften the depression as well. While small amounts of neurotoxins and fillers can give a pleasing, relaxed appearance, too much of these products can cause an unnatural appearance. The same can happen in other areas such as the forehead or lips. Good luck.

You want to make sure your injector is experienced in this area.  Everyone has different facial anatomy.  Your results generally will be different than another persons, even though the product is injected in a similar fashion. 

The only way to avoid this problem is to select an experienced physician whose results you have seen. That surgeon should provide multiple examples of their work.

Please ignore advice, such as that below, from plastic surgeons suggesting you only see a plastic surgeon. Because filler injections are an art as much as it is a science, it is especially important to remember that the experience and technique of your physician injector, not their specialty, is the most critical part to your achieving a beautiful, natural result. Albert Einstein is quoted as saying, “The only source of knowledge is experience”. It's best to communicate your concerns to your doctor.

 I have used fillers to augment and shape the face for 25 years.  The Joker smile is caused by over-filling the "Marionette Lines" in front of the Jowls, especially when using a thick filler like Radiesse.  A reasonable amount of Perlane to soften the area work great IMHO.  This look can also be the result of too much Botox to the Depressor muscles, of the lower lip.  

Make sure you have a board certified plastic surgeon perform the treatment, injectable fillers look best when not over done.