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!

This looks like a marginal mandibular branch  of the 7th (facial) cranial nerve. Botox might help, but you will need a formal consultation to see if you're a good candidate. Best wishes, Dr. Aldo

Hello LovelyM23,
Your problem is not unusual.  I have seen at least a dozen just like it - in fact my daughter has the same problem.  About every 4 months I inject a small amount of botox which solves the problem.  It will take an experienced injector but you should not have a problem finding one. Be sure to ask if they have treated this problem before.  Good Luck
Clifton Smith, M.D.

As you can see from my colleagues below, it is possible, but you must see someone with a lot of experience such as a Board Certified Plastic Surgeon. Check the American Society of Plastic Surgeons website to find the ones in your area and then schedule a consultation to be examined in person. Best of luck.

Botox or Dysport can help with an asymmetric smile due to a facial nerve (7th cranial nerve) palsy. However, the 9th cranial nerve works on the tongue and palate and I do not believe Botox/Dysport is used to correct this. You said 9th cranial nerve but did you mean 7th cranial nerve?

If the defect is the 7th nerve it has affected your facial expression but if it is the 9th that is the effect on the tongue. Botox could possible help on the contralateral side but see a board certified neurologist to determine which nerve is involved and what to do

Having facial or 7th nerve paralysis condition will not benefit from using Botox except in very unique cases. It will make your smile even worse and probably weaker, so your mother is correct. Good luck from New York City