I had Botox on my jaw to slim it down. Left side can't smile, 4 days post-op. Advice? (photos)

Question

I had botox 4 days ago on my jaw to get the slimming procedure and since then I can't smile in my left side if my face and my right is totally distorted. My therapists said 'it'll even out!" Do i just let this wear off and not smile for months ?!

Hung William Song, MD · Answer

Hi, the reason this is happening is because the DOA muscle (depressor anguli oris) was unintentionally treated. A simple fix would be to treat the DOA on the other side as well to make the smile even. We routinely treat the DOA's on both sides on purpose to help raise the smile. Speak to your doctor about doing this to correct it. If your doctor is not familiar with this technique, find someone who is. Treating the lower face with Botox is off label and should only be done by practitioners who are experienced and properly trained.

Adam Tattelbaum, MD · Answer

Sorry to hear you  are having any concerns. Early on this may be related to bruising and or swelling. Botox usually takes about 7- 10 days to see an effect. If it does not resolve  soon don't panic as it will go away  over time.Best wishes.

Ram Chandra, MD · Answer

I think Botox went beyond the intended muscle for jaw shaping, namely masseter.
Treating the right depressor anguli oris muscle with a few units of Botox or Dysport might correct the uneven smile.

Daniel Chang, MSc, MBBS, MRCS · Answer

Dear stormstar,Thank you for your question.Jaw slimming is a commonly performed procedure here in Asia. What you mentioned is most likely a side effect of treatment. Did you undergo dysport or botox treatment?1. Dysport takes 3 days to start weakening the muscle. Your risorius muscle may be affected, causing this. 2. Swelling post jaw slimming is rather uncommon in skilled hands, so in my mind, unlikely to cause this.3. Botox on the otherhand, takes 5-7 days to start weakening your muscles.I hope this helps. Whatever the case, side effects are temporary and your muscles will strengthen with time, so dont worry!

Steven Wallach, MD · Answer

First, botox usually takes about 7 days to take full effect. Second, the injection  may have went too close to your muscles of animation.Hard to say for sure without seeing you.

Jo Herzog, MD · Answer

Four days is not very much time for your Botox to have become fully effective. It is still possible that you might get more evening out over the next week and it is also possible that the peak effect that is causing the distortion might weaken enough for this to be much less noticeable over next week. Do not panic yet, give this a little more time.

C. Coleman Brown, MD, FACS · Answer

Hello,This is unfortunate but thankfully temporary. There is no good “antidote” to Botox but time. I would recommend massaging your face and working/activating as many facial muscles as you can throughout each day. You might also consider a microcurrent facial. Likely a little Botox got into the muscles of facial expression instead of just the jawline. Good luck,

Kurt Kuhlman, DO · Answer

I assume your injector intended to inject the masseter muscles to slim your face, but inadvertently injected the smile muscles located just in front of the masseter muscle. Unfortunately, there is nothing you can do at this time. Your smile will slowly return to normal over the next few months.

I had Botox on my jaw to slim it down. Left side can't smile, 4 days post-op. Advice? (photos)

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