Terrible smile distortion after TMJ Botox, do I need different doctor? (Photos)

I am completely unfamiliar with the concept of Botox spas.  I think you are better served in a facility with a board certified facial plastic surgeon, plastic surgeon, or dermatologist.  Having said that, your smile is likely altered due to injections that were placed too high into the massester muscle and some weakening of the muscles responsible for your smile.  If your next provider places the majority of the Botox or Dysport into the lower body of the masseter muscle and waits to see if the temporalis muscle needs to be injected at all you will avoid the distorted smile issue you are experiencing and still get the benefit of TMJ pain reduction.  

While I can read clearly what you wrote, consider reposting with some marks on your face as to the injection points that were used.  I would like to see what you mean by temporalis and masseter as this really should not have happened if those areas were injected.  

Hello and I am sorry you are experiencing this side effect from your Botox injections. While Botox is a common procedure, it does require a great deal of precision and accuracy in injection placement to yield the best possible results. This procedure should only be performed by a board-certified dermatologist/plastic surgeon who is also a Botox expert. In your case, it appears the injection placement was slightly off and may have hit your risorius or zygomaticus muscles, and this resulted in the changes to your smile. The results will wear off in three to four months. At that point, find an experienced doctor for your next treatment and you should see better results. 

This is due to injector error and the botox was placed too superficially and medially - so that it affected the risorius muscle.    Your smile will eventually return to normal after the botox wears off.   This could take several months.  
In the future - you should look for an experienced injector who does this full time and understands the underlying anatomy.   My suggestion is when you look for your next provider - test them and ask them if they have encountered this problem before.   Ask them why this happens.   If they can tell you it's due to accidental injection into the risorius muscle - then they are probably the right person for you.

The masseter muscle is near the muscles for facial expression. These muscles were inadvertently affected. Thankfully this will go away. Sometimes it improves after several weeks, and sometimes you have to wait 3-5 months for the Botox to wear off completely. If your bite strength is not weak, then you don’t need less next time, but I’d consider using another injector who does TMJ Botox regularly. It needs to be injected precisely. The first time I had it, I did 20 on each masseter and couldn’t chew hard foods, but it didn’t affect my smile at all. I now use 10 in each masseter and 20 in each temporalis (but the temporalis is more for migraines). Good luck. It may take some tweaking to find the right injector and amounts, but it’s possible to get relief and keep your beautiful smile. 

Thank you for sharing your question and I am sorry that your results have not been what you anticipated.  It appears that some intended muscles became weakened and this is most likely injection related to your masseter treatment.  Fortunately the symptoms will resolve spontaneously with time, but as these are a more advance injection technique, be sure to invest in a specialist for any future treatments. 

Thanks for your question, These treatments require specialists in my opinion. The great news is that long term damage or issues is very unlikely as this medicine will wear out eventually. It will likely take 2-5 months for this to improve.

The clench muscles of the face (masseters have their greatest bulk at the side of the cheeks just above the jawline. If you clench, you will feel this muscle tighten and you can follow it's course from the angle of the jaw up towards your cheekbone.
Botox injections for TMJ pain should be done at the third of that muscle which is lower on the cheek and toward the angle of the jaw. That location is well away from the smile muscles of the face - zygomaticus and risorius. If injected toward the upper third, there is a risk of affecting zygomaticus. I suspect that may have been the case in your situation.
Given the amounts injected, full recovery of your smile is expected at 3-4 mths.
I typically don't need to inject temporalis to achieve TMJ pain relief.

Sorry to hear about your smile post botox injection.  Usually this is not something we see after TMJ botox injections.  After performing thousands of TMJ botox injections, I have never encountered such an issue, but nevertheless it could happen to anyone even myself.  The units of botox used on you are actually very small.  My patients usually require 100 - 200 units depending on their size and symptoms.   The injections are performed every three to four months until relief is achieved. By staying deep into the muscle and following correct anatomical locations these issues can certainly be minimized or avoided altogether.
wish you all the best.
Dr Aynechi

I'm sorry that you are having issues after your Botox treatment.  One of the risks of injecting this area is it affecting the smile.  Fortunately this effect is temporary and your smile will return to normal over the next few months.  In the future you may want to consider an injector who is experienced with injecting this area regularly.