Botox for asymmetric smile? (Photo)

Question

I had a childhood operation (not sure of the nature) which left me with a scar on the right side of my neck, a crooked smile as well as crooked speech. It is much less noticeable with a closed lip smile. I would like to know whether Botox to the unaffected side would be helpful and which muscle/s in particular would need to be targeted. Thank you.

Aldo Guerra, MD · Answer

Thanks for this great question. Since this was a childhood surgery, it is unlikely that the nerve will come back. You have a nerve palsy (marginal mandibular nerve) that prevents the right corner of the mouth from being pulled down when you smile. The best treatment would likely be to relax the opposite side to ring the left corner up. The most famous asymmetrical mouth is, of course, Sylvester Stallone who was born with the same nerve defect that causes his bottom lip to look higher when he smiles/grimaces. I suggest you speak with an experienced injector and consider a combination of dermal filler and neuromodulator. You can also try Dysport or Botox without the filler to relax the muscle which pulls the mouth corner down. Best wishes always, Dr. ALDO :)

Jason Emer, MD · Answer

Fillers and botox can be used to improve this area. Lasers or surgery can sometimes help asymmetry.  See an expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  In order to balance out your smile you would need to have Botox placed in the areas of the left lower chin where the muscles responsible for pulling the lower lip downward exist.  This typically involves treatment of the depressor anguli oris and depressor labii inferioris.  Hope this helps.

Hardik Soni, MD · Answer

Thank you for your question. Since you had this surgery in your childhood it is unlikely the nerve will come back. This can be treated by relaxing the opposite side to bring the left corner up. I recommend having a consultation with an experienced injector to determine the best treatment plan for you.

Jill C. Fichtel, MD · Answer

Nerve damage from the operation is likely what caused this asymmetry to begin with.  Botox can help improve (but not completely fix) the asymmetry.  I strongly recommend seeking out a board-certified Cosmetic Dermatologist or Plastic Surgeon for an in-person evaluation.

Shaun Patel, MD · Answer

Yes, Botox will help with your asymmetric smile. Your right marginal mandibular nerve was likely injured at the time of surgery and so the lip depressor muscles on the right side of your lower face are not functioning properly. Botox injection into the left depressor muscles (DAO and DLI muscles) will help even out the smile. Botox results are temporary and you will need to have the injection 3-4 times per year. I would see an experienced injector as the lower face anatomy is complex and advanced injection techniques are required.

Manjula Jegasothy, MD · Answer

Botox Cosmetic® injected into the lip depressor muscles to even out a evoked smile is a very advanced technique and should be undertaken only by a very experienced physician, utilizing small doses over a period of time and number of sessions.

Melvin Elson, MD · Answer

Since this was done many years ago there will be no regeneration but Botox injections to the unaffected side could even up the smile even though it wont look great it should look better

Steven F. Weiner, MD · Answer

This is caused by a nerve being cut during your operation. To make things symmetric, injecting the left DLI with Botox will help. However, the movement of food around your mouth will be impaired. You can try it and see how you like it. It will always go away in about 3-4 months.

Samuel Siddiqui, MD · Answer

Thank you for your question.  For asymmetric smile the chin muscles which pull the lip down are targeted with botox to weaken the downward pull on the side where the lip is lower when smiling.  Muscles typically injected are Depressor anguli oris (DAO) and sometimes Depressor labii inferioiris.  Your picture is helpful but a video or in person evaluation would even be better.   The muscles of facial expressions are supplied by the 7th nerve (facial nerve) that comes out the skull near the opening of our ear in the parotid gland and then divides in a number of branches. The marginal mandibular branch is the lowest and most likely to be injured at the bony edge of the jaw  because of its superficial location and also as it does not communicate with other facial nerve branches.  It can be injured at this level but not in the neck.  Please see an experienced injector to see what can be accomplished with Botox.  Good luck.

Botox for asymmetric smile? (Photo)

Answers (10)

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