Crooked smile 6 months after Botox? (Photo)

I would recommend looking at your before pictures with the same exact expression being made, to evaluate best whether this is from botox, or possibly a natural asymmetry that was there at baseline. Botox in some patients can last 6 months or more, but this is very rare with most botox injections lasting no more than 3-4 months. If it is from botox  it will completely resolve and go back to normal, but may take some more time. This is why good before and after photography are so important to have. Best, Dr. P.

Botox should only last 3-4 months.  It rare cases it can last up to 6 months. I would assume that this asymmetry will continue to improve.

This is an area that we treat very often and can be very effective to improve a smile, turn up the lip, relax the chin, and retrain muscles to do what we want them to do to make our face look good and make our smile optimal. In addition, often we will treat the masseter muscle that can be a cause of square jaw. However at times, specifically with the corners of the mouth, the product can spread or not be sufficiently injected in one area or another. In addition, all of us are asymmetric both in bone structure and therefore our smile; therefore, if the muscle relaxer was more effective in one area than another, this can often be modified. In general, muscle relaxers last for 3-4 months; in some people, the results seem to last longer. However, if this was an initial treatment, it is most likely that you had a crooked smile to begin with that you were unaware of, and this treatment exacerbated that. There is a recent study that shows that if you exercise this muscle or any muscles that have been over treated, you will more quickly have that muscle working normally again. So, my advice is to speak with your initial injector and make sure that he or she has seen it because often we can do a touch up if one area is under corrected. If this is due to the muscle relaxer use, then exercise that area. For example, frown. Smile. Frown. Smile. This can reduce the duration of the effect of the muscle relaxer by 50% or more. Thank you for your question and best of luck.

The effects of botox typically will last 4 months, sometimes a bit more.  At six months after treatment, there is likely little or no effect of the medication left.  Often times, these asymmetries go unnoticed until you really start paying attention to them.  Facial asymmetry is really the rule rather than the exception.  The muscles that bring down the lower lip are innervated by a branch of the facial nerve that can be damaged by conditions such as Bell's palsy or a benign tumor of the head/neck area.  If the asymmetry is new, you should definitely have it investigated.  If it has been present all of your life and just not noticed, and it bothers you, you may need additional treatments or to keep up with them on a more frequent basis.  Good luck.

This is due to the DLI on the left side not working well. It is hard to believe this is Botox related. I would get an ENT evaluation to see if there are other facial nerve problems. This is fed by the marginal mandibular nerve. Is it possible that this nerve was injured during injection?