For how long has Masseter Botox ruined my smile? 4 weeks, 4 months or forever? What went wrong? (Photos)

I saw a Dr for grinding & clenching my teeth causing jaw pain.He injected dysport equivalent of 30 units Botox/side (small circle in centre of masseter).2 weeks later my smile is awful & embarrassing! I went back & he said there was no way the dysport had spread, it wasn't his fault & it should be fine in 1-4 weeks.I think he is wrong.With a straight face I also see sagging in the centre of my face.He said the masseter effect will last a year- will this freaky smile & volume loss last that long?

Doctor Answers 8

Smile Affected Post Botox/Dysport Treatment

I do notice the difference in your smile from the pictures you provided, but i have to admit it doesn't look that bad. Botox and Dysport typically lasts 3 - 4 months and in some rare cases, 6 months to 1 year. So your smile should get back to "normal" soon. Be patient and Keep Smiling!

The neurotoxin effect can last up to 6 months but on average is 3 to 4 months

the effect of the neurotoxin can last up to 6 months for few individuals. but as far as majority of patients, this could be more three to four months period. Be patient and even after few weeks, since the masseter is a strong muscle, you may start have your normal smile back. 

For how long has Masseter Botox ruined my smile? 4 weeks, 4 months or forever? What went wrong?

Hello mrc3121,

The result you are seeing is the result of your treatment for your TMJ.  I am not sure why your physicain would indicate it wasn't from the injection.  It appears the injection was a little far forward or it spread there.  Although this is one of the risks of injection of the TMJ, since it was affected on both sides it seems more technique based as opposed to simply spreading there.  The good news is, the effects are only temporary.  They will last about 3-4 months from the time of injection.  If you go get relief of your TMJ pain, then continuing with the injections can help.  By using proper techniques and not injecting so far forward, you can keep your pretty smile and still get the TMJ relief.

I hope this helps and good luck. 

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Changed smile

Your smile seems to look different after your treatment in the pictures.  This is likely due to the Botox affecting other muscles of the face.  As a result, certain muscles are not pulled/moved as you smile and your smile looks different.  The good news is that, Botox usually lasts 3-4 months.  So, I would expect this to resolve at that point.

Sunny Park, MD, MPH
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Inadvertent spread of Botulinium Toxin into Risorius

Risorius is the muscle that pulls the corner of your mouth sideways during a smile. It starts from the corners of the mouth and is a long horizontal muscle that joins to the Masseter muscles. 

It looks like the Dysport injected have diffused into the Risorius muscle. Common reasons are due to :

1. Large volumes of dilution ( recommended dilution of Dysport is 2.5mls in 500 Ipsen units, some Allergan Botox users may try to use dilution of 5mls for Dysport for ease of conversion of the units from one brand to the other, thus causing a higher chance of the Dysport flowing elsewhere from the point of injection)

2. Inappropriate placement of Dysport too anteriorly and too near to the Risorius

3. Excessive bending over forwards in the first 4 hours after Dysport injection into the masseter causing inadvertent diffusion into the Risorius.

There is no treatment for this once it occurs but to wait it out for a month or two. Keep on smiling strongly everyday to strengthen the risorius against the effects of the Dysport may help you to recover faster too.

Do look for a more experienced injector next time!

Israr Wong, MD
Singapore Physician

Keep smiling

This area of injection can look and work fantastically.  Don't get discouraged.  Please reconsider doing this when your smile is back to normal - should last on average 3-4  months.  Be sure to find an injector who has experience with this area of injection.  It may be beneficial to start with smaller amounts of product and add additional until desired result is achieved.  As we know with neurotoxin, you can always add more, just can't take it away.  Good luck!

Landon Pryor, MD, FACS
Rockford Plastic Surgeon
4.8 out of 5 stars 37 reviews


Luckily Botox or Dysport only lasts about 3-4 months so your smile should return to normal. The product simply doesn't last that long. In my opinion the botox got in to the muscles of facial expression instead of the masseter muscle. I have done hundreds of injections in this area and none have lasted up to a year. I hope that gives you some comfort. Best of Luck!

Robert Heck, MD, FACS
Columbus Plastic Surgeon
4.8 out of 5 stars 60 reviews

Abnormal smile after masseter Botox

This is a problem with improper injection. If the Botox is placed too anteriorly, the risorius muscle is weakened. This will resolved in about 8-12 weeks. The risorius muscle pulls the corners of the mouth wider and sits just in front of the masseter.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 26 reviews

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.