Which Muscle is Botox Injected into Correct Slightly Lopsided Smile?

I had a midface procedure that has given me some nerve injury, its been almost 3 weeks, I can smile wide and force movement but if I smile naturally my lips cover my teeth more on the right side, would it be the levator labii superioris alaeque nasi that is injected with a few units of botox to regain symmetry on the other side? Can this give the look of a more prominant nasalabial fold? or would it be another area on the cheek that effects lifting the corner of the lip that should be weakened.

Doctor Answers 6

If your facelift has given you a lopsided smile, do not get Botox from someone else before seeing your surgeon.

It's good to see you are online doing some research about healing after your midface procedure. It is unclear from your post whether it was a midface surgical lift or midface injectable fillers, but either way, the fact that you are able to force an even smile is a good sign that the nerve may be temporarily injured, but has a good chance of gradual full recovery. Nerves are amazingly resilient and if not fully severed, will usually regain functionality over time.

Please do not seek answers like "Botox on the other side" until you have returned to your surgeon for follow up visits and discussed his or her expectations for recovery. Intentionally weakening an opposing side is not as predictable or easy as it seems you may think, and you could end up unable to smile on either side, or risk a nerve injury on the other side, instead of having just one side to deal with.

It's great that you are researching the muscles and nerves so you can understand what's going on in this situation, but facial expressions are much more complex than a diagram and smiling is created by the functions of several muscles working together (the same ones that also help you eat and speak--so use caution). Please see your surgeon before you ask someone for Botox or Dysport.

New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

Botox to correct asymmetry

It is very difficult to answer your question without first seeing you in person to assess the specific issue. Sometimes waiting for swelling to subside (and some healting to occur) is the best answer initially, rather than risk potential side effects of trying to correct too soon.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Which Muscle is Botox Injected into Correct Slightly Lopsided Smile?

 Motor nerves injuried during Face Lifts are quite uncommon and there are multiple branches innervating the upper lips, so this might get better in the following weeks.  I'd ask the plastic and cosmetic surgeon that did your Face Lift but I'd think it more prudent to force exercise your lips than further weakening them by Botox injections to the other (working side).  Yes, you are correct...that is the muscle that lifts the upper lip. 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Have to agree with Dr. Ruecki here.

A little of tincture of time is recommended here.  Many of these motor nerve injuries do get better in time.  Having Botox injected risks making you look even worse and perhaps for a much longer time than how long it will take fore the motor nerves to begin to recover.  Remember that it is possible for some weakness to be permanent.  If that is the case, then it makes sense to consider some type of treatment to help balance the face.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Slightly lopsided smile after surgery, can Botox help

While I know you want this fixed, here's my opinion. Most facial nerves (and actually many nerves in the body) work to correct themselves, re-attach, and function normally. If you have Botox put into the ininjured side, and the other side does fix itself quickly, you will now have another form of asymmetry with the Botox side falling lower again. So, I while you think it doesn't look great at this moment, at only 3 weeks post surgery, I wouldn't do any type of correction because you don't want another round of asymmetry or you're just going to be chasing your tail to correct, recorrect, and recorrect again. Wait for at least 3 months post surgery, and then assess with a board-certified injector.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Botox for smile asymmetry is tricky business

I think you are thinking along the right lines anatomically, injecting the 'uninjured' side to weaken your lip elevators (LLSAN and other muscles) innervated by the buccal branch of facial nerve would probably work - but may result in a new type of asymmetry. I personally would wait this one out - most facial nerve injuries recovery spontaneously and you should have full lip elevator function back in a few months.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

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