Crooked smile due to facial nerve damage, would Botox be a solution? (Photo)

This is a great question and I have treated many patients with this problem using Botox. The injections of Botox are performed on the normal side over a few appointment's to create more balance to the face. There is no evidence that botox causes any permanent damage to muscles.

In your photograph, it appears that the marginal mandibular nerve (branch of cn 7) has been affected.  Facial paralysis results in one portion of the face not moving or only partially moving.  When the face animates the non affected side’s movements are often pronounced and can sometimes create abnormal movements called synkinesis.  By placing botox in the overly active side (i.e. the NON-Paralyzed side), the facial movements can look more symmetric in appearance.  This is most easily performed in the upper face and the lower face requires expertise in facial anatomy and facial paresis.  

LovelyM23- Thanks for your question.You have a unique problem that Botox may help- but not in the way you might think.  From your photos and history, I suspect you either suffer from an absence vs. birth trauma of the marginal mandibular branch of the facial nerve (cranial nerve VII) OR you have congenital underdevelopment of the muscle that pulls the corner of your mouth down (congenital hypoplasia of the depressor anguli oris muscle).  Botox only works by paralyzing muscles - thus will NOT help the side that is already affected.  However, if smile symmetry is your greatest concern, botulinum toxin can be used on your "normal" side to weaken that muscle and prevent the lip on this side from coming down.  This would, in effect, leave both sides weak and result in a more symmetry smile.  This may not be something you want, or maybe it is?In addition, there are surgical procedures that involve movement of another muscle into the lower lip to help retract it, but these can also have varied success and involve other risks.To find out more and what is right for you, I would suggest an in-person consultation with a board-certified Facial Plastic and Reconstructive Surgeon.Best wishes!