Can Botox fix my asymmetrical smile?

Question

My right (picture left) corner of mouth pulls way further than the other side when I smile and kind of makes the corner of my mouth look like female genitalia and there is an extra c shaped wrinkled on that side that doesn't exist on the other. Can Botox keep that side from pulling so far and balance my smile?

William Groff, DO · Answer

Thank you for your question. Botox is a neuromodulator that works by relaxing facial muscles. It is commonly used to smooth away wrinkles on the forehead and around the eyes. An experienced injector might also use the neurotoxin to enhance the shape of the lips or to reduce the appearance of lines around the neck. 
The success of Botox relies on the experience of the injector, as well as precision in needle placement and dosing amounts. For small corrections, less is always more. You might be able to achieve subtle correction in this are using very small amounts of Botox. However, it is also possible the treatment will alter your smile to make it less appealing. I would weigh the risks carefully against the small amount of improvement you stand to achieve. It is likely the treatment would not be worth the risks.

Stephen M. Krant, MD, FACS · Answer

Yes, but the Botox dose should be very small (possibly 2-4
units) to weaken the pull. Don't try to overdo it with the first dose. Go to
someone with extensive experience with Botox. 
Good luck!

Kimberly Butterwick, MD · Answer

From your photo it appears you have some mild asymmetry on one side of your smile that can likely be addressed using precise Botox. Botox is a neuromodulator that works by relaxing facial muscles to eliminate wrinkles or correct some asymmetries. While this is an outpatient treatment performed by injection, it does require a degree of precision in terms of knowledge of anatomy, placement and dosing amount to achieve a natural result. Make sure you work with a board-certified dermatologist and expert Botox injector to ensure an optimal outcome. 
Botox injections take just a few minutes to complete and do not require any numbing medication in most cases. There is no downtime after the procedure. Your full results should develop within two weeks and last for three to four months. Because the treatment is temporary, you will need to have regular sessions to maintain your positive look.

Ron Shelton, MD · Answer

You should see a true board-certified expert that deals with off-label uses of Botox and will examine you in-person to evaluate your anatomy and understand why the right commissure of the corner of the mouth is pulled out much more than your left. If the masseter muscle is hypertrophied signficantly more on the right then when the muscle that pulls the smile out to the side has to ride over this bulge it will pull it out further. If it's a congenital asymmetry of the rhizorius muscle as an example, possibly very low dose of Botox may weaken it and provide better symmetry. However there is no exact science as to exactly where to place the Botox and how many units so a provider should start with a very low dose. If you're unhappy with a side effect, such as a facial droop on that side, difficulty saying certain letters, brushing your teeth, etc. you would have to wait 12 to 16 weeks for it to return to normal.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Elham Jafari, MD · Answer

Hi and thank you for your question! While in theory it is possible to do adjustments to the shape and form of smile, it is quite difficult to achieve desirable results and even if it works well one time, since Botox effects are temporary, it will go away soon and you need to redo it, and risk unexpected results again. Some degrees of asymmetry is natural and is present in everyone and based on the picture, your smile does not seem to be noticeably asymmetry (although I understand that it is how you feel about it that matters). Given all, I do not recommend doing Botox for this indication. I hope it helps and good luck!

Michael A. Persky, MD · Answer

Hi NDancer,The corner of your mouth certainly does not look like female genitalia!!! (if so, it is the prettiest female genitalia in the world.)  I would be very hesitant to use neuromodulators (Botox) to attempt to even your smile because it could lead to severe asymmetry issues (still would not look like genitalia, male or female!!!)  After examining you in person, a little filler in the corner of your mouth may help your achieve your aesthetic goal.  Good luck and be well.Dr. PEncino, CA

Jason Emer, MD · Answer

Facial sculpting and contouring can be created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra, which would give improvement in facial balance. Fat or implants are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Your smile is beautiful and well-balanced, and the degree of asymmetry you mention is very subtle.  I fear Botox treatment would only afford you a greater degree of difference in your two sides and would not recommend further treatment.  Hope this helps.

Monica Bonakdar, MD · Answer

Thank you for your question and photo.  Botox Cosmetic was the first neurotoxin that was FDA approved for aesthetic uses in the US. Although correction of an asymmetric smile is an off label use, it is possible for an expert injector to correct such an asymmetry with Botox Cosmetic. The challenge is that if the injector does not have expertise, you will have to live with an undesired effect for three months before it goes away. So, you need to see a master injector who is competent in this particular area. A board certification does not guarantee competency in any and every particular area of aesthetic medicine.
Best Regards,
  
Monica Bonakdar MD

Trilogy Medical Center - Midvale · Answer

Thanks for your question and picture. There are several muscles involved with pulling the smile where yours pulls. IF it bothers you enough to want to experiment, a SMALL amount of toxin can be strategically placed to lower the hyperactive side. However, you need to know that doing this has the chance of lowering that side too much, although when dosed very conservatively, that likelihood is small. You'll want to make sure you see someone who is experienced!
Hope this helps,
@DrKatNP.trilogy

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