Is Botox more likely to go wrong if it has before? Am I doomed to a crooked smile forever? (Photo)

Hi! In reviewing your photos, it looks like the DAO movement has returned as we can see more lower teeth in the September photos than April. However, I do see the asymmetry that persists even now. I believe the opposing DAO strengthened over the last few months. I would consider a very judicious amount of Botox injected intentionally into the DAO that was not impacted and now seems to be stronger. This could have also been done in April when the DAO was first impacted- your smile would be smaller for a few months but symmetrical. There is possiblity that it will occur again. You can see your regular injector again, but inform them what happened and ask their plan to prevent it from happening again. Injection points, concentration, and dosing can all be adjusted as needed.

Hello, and thank you for your question. I'm sorry to hear about your experience with Botox. Here are some insights that might help address your concerns:

Botox Migration: While Botox migration is relatively uncommon, it can happen, especially if the injection technique was not optimal. However, having experienced migration once does not necessarily increase the chances of it happening again. It is crucial to ensure that your injector is highly experienced and understands the anatomy of the facial muscles well.

Muscle Memory: It's unlikely that your muscles have "learned" to be lopsided. Botox works by temporarily paralyzing specific muscles, and its effects typically wear off within 3 to 4 months. Any asymmetry you are experiencing should gradually diminish as the Botox effects wear off completely.

Returning to Your Regular Injector: Yes, you can certainly go back to your regular injector. It is always beneficial to stick with a provider who knows your facial anatomy and has a history of successful treatments with you. Be sure to discuss your previous experience in detail so they can adjust their technique if necessary.

Corrective Treatments: If your smile is still slightly lopsided, your regular injector might be able to use a small amount of Botox or another treatment to balance out the asymmetry. Additionally, they can provide a thorough assessment to ensure that any future treatments are administered precisely to avoid similar issues.

Consultation: I recommend scheduling a consultation with your regular injector to discuss your concerns and develop a plan to achieve the best possible outcome. They will be able to provide personalized advice based on your specific situation.

Remember, Botox is a temporary solution, and any undesired effects will eventually wear off. With the right injector, you should be able to achieve a balanced and natural-looking smile again.

Warm regards,

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. If Botox in your depressor anguli oris (DAO) muscles has migrated and caused a lopsided smile, it’s understandable to be concerned about both the migration and the persistent asymmetry. Botox migration can occur if the product spreads beyond the intended muscle area, leading to uneven effects. While it is not always a direct result of previous migration, it can happen, particularly if the dosage or placement was not ideal. The asymmetry in your smile may persist because the affected muscles could be responding to the altered balance as a new “normal,” but this typically resolves as the Botox wears off and the muscles regain their normal function. The effects of Botox generally last around 3 to 4 months, so some persistence in lopsidedness is likely due to the ongoing influence of the toxin. Returning to your regular injector, who is familiar with your facial anatomy and previous treatments, could be beneficial. They can assess the current situation, provide targeted adjustments, and help address the lopsided appearance. It’s best to wait until the Botox effects from the previous injector have fully worn off before proceeding with any new treatments. This ensures that your regular injector can accurately evaluate the situation and make informed decisions about restoring balance and achieving your desired results. I hope this helps and best of luck!

I’m sorry to hear that you had this response. I would first wait until the Botox has completely worn off before doing anything else. The migration should not be more likely a second time because it occurred the first time. As for the muscles “thinking its the new normal” - like all muscles they will compensate for a deficiency. The body will recruit from adjacent muscles to do the job. Whether this happened in your situation is impossible to know from the photos.
You probably want to see a dermatologist or plastic surgeon who is very experienced as an injector of botox to have a complete exam and discuss next steps. He/she will be able to assess more closely the perioral musculature.

The one good thing about Botox is the results depending on the patient is 2-3 months typically rarely lasts 6 months time so any asymmetry caused by Botox would resolve within that time frame. No this does not increase the change of migrating the more you inject Botox, your muscles dont acclimate to Botox since it resolves in the above specified time. I think what happened is they injected too many units on 1 side. I would start no more than 1 unit on each side depending on the strength of the muscle and then come back in 2 weeks to see if you need more.

I'm sorry that you had issues from your Botox treatment. The effects of Botox are temporary and your smile should return to normal once the product has worn completely off. Be sure to let your regular injector know of your prior experience.

Previous 'migration' of toxin shall have no bearing on future toxin administration. Having said that, ways to minimize the risk of a similar outcome, include the use of a lower amount of normal saline (solvent) to create the Botox solution, and to use less product and in a more anatomically targeted way. Please note that you could also have some additional or aberrant muscle fibres away from the normal location at which they are found; so, do advise a new/ different injector of your previous experience (for awareness).