All of a sudden I have a crooked smile, why and what to do? (Photos)

Question

I had Botox or fillers (I don't recall which) about 9 months ago to turn up the corners of my mouth slightly. All of a sudden now I've noticed that the left side of my mouth drops down when I smile. This has never happened before and I don't know what's going on or how to fix it. Should I get more injections to fix it?

David W. Rodwell III, MD · Answer

Your right side is actually the weak side.Noticing this 9 months after a treatment makes it much harder to speculate about a cause.  There are ways that Botox and fillers intended to turn up the corners of the mouth could have an impact on your smile leading it to appear crooked.  However, if that were to happen it should be something that happens soon after the injections. I would recommend checking with the person who did your injections.  The first step in figuring this out is to know exactly what was injected and where it was placed.  You also need the person evaluating you to have a good understanding of the anatomy of the mental nerve as well as its origins within the entire course of the facial nerve to properly assess your current situation with new onset weakness many months after a procedure.

Shaun Patel, MD · Answer

An asymmetric smile can be seen after Botox injection to the DAO muscle (performed to raise the corners of mouth) if the Botox diffuses to the adjacent DLI muscle. That being said, this would typically be seen within 2 weeks of the injection being performed and not 9 months later. I would followup with your injector to discuss your issue.

Mohammad Almohideb, MD · Answer

You probably had Botox injected to the right depressor labii inferioris muscle that usually pulls the lip down. This can be corrected by injected 1-2 units on Botox to the left depressor labii inferioris muscle to weaken it and balance your smile.

Jesse E. Smith, MD, FACS · Answer

While fillers and botox may well be the cause of your issue, an asymmetric may well be caused by issues with the facial nerve branches as well.  These can be related to viruses or tumors.  It would be a good idea to visit a physician that can examine your face and cranial nerves and offer possible treatment options based on their findings.

All of a sudden I have a crooked smile, why and what to do? (Photos)

Answers (4)

Answer: Asymmetric smile

Answer: Asymmetric smile

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Everything you need to know about Botox

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All of a sudden I have a crooked smile, why and what to do? (Photos)

Answers (4)

Answer: Asymmetric smile

Answer: Asymmetric smile

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.