Crooked smile 6 months after Botox? (Photo)

It's been over 6 months since I've had Botox injected into my chin and my mouth is still crooked. Is there some reason this may be why? Or how can I fix this ?

Doctor Answers 9

Crooked smile still after 6 months

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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?

Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews


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Where on your face was the botox injected?  Have you had any fillers?  Have you ever had "Bell's Palsy."Botox has an effect for typically 3-4 months.  I would love to see photographs of you prior to having had the botox injected. More than happy to assist if the additional information is provided.

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon

If the muscle relaxer was more effective in one area than another, this can often be modified

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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.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

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Botox injections

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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.

Kaleroy Papantoniou, MD, FAAD
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Botox only lasts 3-4 Months

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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.

Martin Jugenburg, MD
Toronto Plastic Surgeon
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Botox effects

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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.

Brian A. Pinsky, MD
Long Island Plastic Surgeon
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Botox results

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Usually, Botox results last 3-4 months and so at this point after your injection, any Botox effect should have worn off. There are many reasons for facial asymmetry including such conditions as Bell's Palsy. It would helpful to see a set of pre procedure photos to determine if you had this asymmetry prior to your treatment.

Crooked smile

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Botox usually lasts 3-4 months it is always nice to compare pre treatment photos with the present look. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Asymmetric smile after Botox

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Thank you for your question scaduto421. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expressions. In the lower face a small amount of Botox can be placed in the mentalis muscle to address dimples on the chin or in the DAO muscle to lift the corners of the mouth. A possible side effect is an asymmetric smile if it spreads to the neighboring DLI muscle. Normally Botox wears off after 3-4 months. But with high doses it could last longer. Please follow up with your doctor for specific recommendations.  Good luck!

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.