Uneven smile after Botox in the masseters. (Photos)

Question

I got 30 units (each) in my masseters about 6 weeks ago to slim my jaw, with TMJ as a bonus. My face appears to have slimmed marginally but my smile is now uneven (see pics). I assume this means the Botox spread into the surrounding muscles. Two questions: 1) how long will it take my smile to return to normal? 2) I do like the face slimming and teeth grinding benefits, but not at the cost of my smile. Should I not pursue this procedure again, or do I just need a different doctor?

Robert M. Tornambe, MD · Answer

Sally, so sorry you are having this problem, but it should improve over the next few weeks.  Some of the Botox seeped into the muscles that affect smiling.  Rare but happens. If you like the look, try again.  Be certain your injector is a board certified plastic surgeon or dermatologist. Good luck!

Eric M. Joseph, MD · Answer

Your smile asymmetry is mild, so most people may not notice it. You probably notice that the corner of your mouth on your left doesn't raise as high as you are used to when you smile. Miss Sally, make sure the fullness at your jaw is all due to your masseters, and not from enlarged parotid salivary glands. An examination is all that would be necessary. I would like to see more of a slimming effect after masseteric Botox, and the fact that your smile was affected by this treatment may not preclude pursuing another treatment when this wears off. Hope this helps! Dr Joseph

Sean R. Weiss, MD, FACS · Answer

Botox is great treatment for enlarged Masseter Muscle.  It can narrow the jawline and create a more slender appearance.  It sounds like your injection was not placed properly and that muscles that help you smile were weakened.  This may take as much as 3-4 months to resolve, but it is likely that it will resolve sooner than that.  It is unlikely that this would happen if you ensure that you are seeing an expert injector who is a facial plastic surgery specialist or dermatologist, so you should feel comfortable trying this treatment again in the future.Best Regards, Dr. Weiss

Aldo Guerra, MD · Answer

Yes, the risorius muscle must have been affected. This is not uncommon masseter injections. There's no way to know when this will go away or whether it will last 3 to 4 months. Nest time, I would suggest a smaller does and an injection into the lowest part of the muscle. You should follow monthly with your injector to document recovery.Best wishes,

Dean P. Kane, MD, FACS · Answer

Dear SallyRS:
Thanks for sharing your photos. They are quite helpful and do indeed show your beautiful smile! I’m sorry for your troubles but the muscle activity in your cheek will return; generally in 3 to 4 months as the action of the Botox wears off. 
  
Diagnosing the proper cause of TMJ and slimming your posterior jawline with Botox takes skill and experience. If you make little or no muscle bulge when clenching your teeth, then Botox injection to the masseter will produce little to no results and jaw surgery will be needed to reduce the jawline width. 
  
The Botox does appear to have diffused into the muscles of the upper cheek causing the lowered nasolabial fold, corner of mouth and cheek fold. 
  
I have found that exercise and TENS stimulation of the weakened muscles may help hasten the process of returning to normal. 
  
Before you know it, your gorgeous smile will return. On your next venture, consult with a well experienced and Board Certified Plastic Surgeon or Oral Surgeon who uses Botox for TMJ and masseter therapy regularly. I wish you the best!

Richard Wellington Swift, MD · Answer

Dear Sally, Thank you for posting your photos with your interesting question. It appears that the 30 Botox Units/side were not entirely injected into the masseter muscles and therefore, affected your smile. This is unusual. I would recommend that you see a Board Certified Plastic Surgeon who is experienced with Masseter Muscle injections. The surgeon should be able to feel and carefully map out the masseter muscle prominence, before the injection. Also, you may require only 20-25  well place Botox units into the mapped out area to achieve a significant reduction of your jaw width, thus creating a more angular and feminine jawline contour, without affecting your smile. Fortunately, the Botox will wear off and your smile will return to normal. Best wishes, Dr. Richard Wellington Swift

Michele S. Green, MD · Answer

It appears that you have a droop from the masseter muscle injection.  The nerve that affects your smile is depressed on one side.  This will improve over the next few weeks.  Botox is a great product for the masseter muscle and I am sorry that you had this side effect but it will resolve over a period of time.  Please consult a specialist in Botox and masseter injections for the best cosmetic results.  Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photographs SallyRS. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The
most common areas of treatment are in the upper face. These include the
horizontal lines seen on the upper forehead when one raises the brows, the
vertical lines seen between the brows when one frowns (frown lines), and the
crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a
formal exam in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information
provided here is useful.Botox can be placed in the masseter muscle in
the lower face to contour the lower face and address pain associated with TMJ.
In this area 20-40 units of Botox are used per side. Depending on the reason
for the enlargement of the muscle, permanent results may be achieved. For
example, some people have a habit of grinding, clenching, or biting their teeth
subconsciously. Often times this happens in their sleep when they are not aware
of it. Botox placed in this muscle will relax the muscle and the grinding,
clenching, and/or biting will decrease. This will reduce the size of the
muscle. If the brain gets accustomed to this and the person stops grinding,
clenching, or biting, then the muscle will not become enlarged or as enlarged
again. However, if the habit starts again, the muscle will likely get larger.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within two weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take two weeks for full resolution. In
addition to these risks, with Botox there is also a risk that the product spreads
or diffuses to nearby structures. Spread to nearby muscles can lead to side
effects such as the temporary appearance of droopy eyelids or a temporary
asymmetric smile. An asymmetric smile can occur if there is spread of the product to the nearby zygomaticus muscles when treating the masseter. In this treatment it is important to place the product low in the face to avoid this possible complication. There is also the possibility of spread if the aftercare instructions are not followed carefully (see below). Most patients enjoy their results for 3-4 months. At that point, if not sooner, such side effects resolve as well.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for four hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific
recommendations. Good luck!

Melvin Elson, MD · Answer

There are 2 methods to treat the masseters. One involves injection more medial than the other and may cause problems with the smile.  See your doctor next time before the injection and suggest he use the 3 injection sites rather than 5 and that will take care of the issue

Shaun Patel, MD · Answer

Sorry to hear about your experience. It appears that your asymmetric smile is due to the Botox diffusing to the adjacent risorious muscle. You will start noting some improvement in your smile after 4-6 weeks but it may take 3-4 months for the smile to return to normal. This is a side effect of the treatment and not a typical result. The Botox was probably placed to close to the margin of the masseter muscle or too high of a dilution was used. I would recommend you discuss your results and concerns with your doctor.

Uneven smile after Botox in the masseters. (Photos)

Answers (13)

More Botox Questions

WE SEND PRETTY
EMAILS

Answers (13)

More Botox Questions

Brow lift Botox gave me droopy eyes?!

I know Botox caused tinnitus... how long will it last or is it permanent?

Can I get Botox if I'm allergic to wasps?

Botox in chin hit DLI muscle (2.5 units), It's 3.5 months on now and the effects are not wearing off

Can Botox lift my upper lip?

I pressed on my forehead after getting Botox injections. Does this increase my chance for droopy eyes?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS