Skewed smile after Botox injections in smile muscles for essential tremor (photos)

Question

I'm an essential tremor patient in my 40s, and as medication (propranolol, rivotril, xanax) are only giving limited relief for the shaking (specifically in my smiling muscles) - the neurologist r we t their botox department for just 4 units Botox in my minor and major smiling muscles in total. We're now months later and the negative side-effects are still there: a skewed smile on one side of my face. Does Botox have a typical timeline, what's my perspective here?

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Christopher C. Lo, MD · Answer

Botox usually works for only 3-4 months, but as the muscles are weakened with the treatment it may take a few more months for the muscle to fully regain its strength.
Be well,
Christopher Lo, MD

Camille Cash, MD · Answer

I'm sorry to hear of the concerns you have from your Botox treatment.  Botox effects are temporary.  for most patients the results wear off gradually over three to four months, although it may be longer for some people.

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum! From your photos, I note moderate droop of the affected side of your upper lip. Botox (botulism toxin) causes localized temporary muscle weakness or paralysis by binding to nerves supplying the muscles and interfering with electrical signal transmission to the affected musculature. Once bound, it cannot be reversed. However, its effect wanes over a period of 3-6 months. If severe, injection of a few units of Botox to the opposite side of the upper lip may improve appearance but may affect speech. It may be best to allow spontaneous resolution.Best wishes...

Skewed smile after Botox injections in smile muscles for essential tremor (photos)

Answers (4)

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