My nose has changed since I had botox for a gummy smile. What is the cause?

I did a gummy smile botox but i noticed that my nose changed .. Its werid i think when i do a duck face my nose Nostrils are different one of them is lower than the other , maybe thats silly but I think its important to know if it can cause a different or my dr did something wrong . And thank you all

Doctor Answers 9

My nose has changed since I had botox for a gummy smile. What is the cause?

Thank you for your question. It is difficult to tell without before and after pictures. If you are concerned, I would consult with your injecting physician. 


Toronto Plastic Surgeon
4.9 out of 5 stars 451 reviews

Botox for gummy smile

Thanks for your interesting question.  Without photographs it is difficult to say what exactly is going on.  In general, since botox causes selective weakening of muscle it can effect the position of facial structures when muscles are used strongly (like when you make a duck face).  If you do not care for the effect, it is expected to wear off in 3 - 4 months.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Botox for Gummy Smile

Without photos it is impossible to say what is happening but I would definitely return to your treating physican for assessment.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 72 reviews


I would like to ask if you could possibly post again, with photos showing you at rest and making the face that elicits the different you are describing.  I have never seen this complication from injecting the levator labii superioris alaeque nasi, and also am not sure what a duck face is.

I am thinking that the Botox spread to either the compressor narus or alar nasalis muscle, which are nearby. I have personally found that using concentrated Botox, just 1 cc for 100 units, prevents complications, as larger volumes spread farther. I would not say your doctor did something wrong, but just that it probably spread farther than intended, so next time, having a smaller and/or more concentrated dose will likely prevent this event.

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 8 reviews

Change after gummy smile treatment

It is hard to tell without actually seeing what is going on but it sounds like some of the muscles under the nose were weakened and although this is unusual it will disappear. to make things more even another injection in the area that is not weakened will help

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 1 review

Notify your doctor

The changes you describe could be from the Botox.
Notify your doctor as possibly some adjustments can be made with the next treatment.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 16 reviews

Botox - did my doctor do something wrong

Thank you for asking about your Botox.

  • Botox for a gummy smile involves injecting muscles near the nose.
  • It can lead to a mild asymmetry - if one muscle responded differently.
  • Or if it revealed an underlying asymmetry.
  • Point it out to your doctor for her/his information -
  • It does not sound as though anything wrong was done.
Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Change in nose

The muscles injected to get rid of a gummy smile make the nose move as well. When this muscles are paralyzed, the nose will act differently. It will resolve when the Botox wears off. 

Yaritza Perez-Soto, MD
Naples General Surgeon



Thank you for your question.

It is difficult to determine without a full assessment. I'd recommend booking a follow-up appointment with your skilled and qualified injector to discuss your options.

Take care.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 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.