I had Botox for a “lip flip” and now, 1.5 weeks later, the right side of my smile is crooked. What happened? (photos)

Question

The right side of my smile is now smaller than my left, with the right upper lip is now dropping down. How long could this take to go away and what happened? I thought this was supposed to lift the lip, not numb it and cause it to drop? Also, the Botox took effect a couple days after the injections, but the crooked smile issue I just noticed over a week later. Is that possible?

Michael A. Zadeh, MD, FACS · Answer

I would tend to agree that the Botox Lip Flip is nothing more than a gimmick. Usually the Botox is used in combination with lip fillers and it is the filler that does most of the work in flipping the lip up. Injecting the upper lip with Botox is a very advanced technique and I have seen way too many undesired results from injectors that don't have the experience treating the area. I would not do anything more than just give it time to wear off. Things will go completely back to normal, but it may take 2-3 months to do so. Make sure you are under the care of an experienced physician injector next time. Best wishes.

Anna Petropoulos, MD, FRCS · Answer

Hello bmoney10, thank you for your question. Using botox or other neuromodulators to augment the upper lip is a very common procedure, but if placed incorrectly can affect the movement & function of the patient's mouth (crooked smile included). To understand exactly what happened in your case it would be important to know the exact placement of the toxin as well as the dosage used by the provider. It's possible they hit an incorrect muscle, used too much/too little, or something else altogether. The good thing about botox is that it fades over time! Even more so in highly mobile areas such as the peri-oral region. Be sure to mention any past complications at your next visit with the injector or a new one so that they can take extra precautions to avoid it in the future. Best of luck! Genie Alexander, RN BSN for Dr. Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

R. Brannon Claytor, MD, FACS · Answer

Botox Botox BotoxThis is not necessarily the answer for everything and can quite  possibly be the cause of results that we consider unfavorable.  The neuromodulator botulinum toxin- A  works by blocking the nerve connections to the muscles.  This often takes anywhere from several days to upwards to a week for it to take effect.  Changing the contour of the lip structurally is what the filler can do.  The Botox leads to decreased animation and over time can improve the signs of fine lines and wrinkles.  A crooked smile that comes on approximately a week after treatment is more likely a secondary result of neuromodulator that has drifted into an area that was perhaps unintended.  Look for an injector who has expertise in facial anatomy specifically a plastic surgeon.  Following up with the injector who did treat you is always a good idea for thoroughness of care.

Jonathan Kulbersh, MD · Answer

This may be due to placement. Fortunately, Botox results resolve in 3-4 months. I recommend following up with your injector. A well-placed touch-up may give improvement. Hope this helps.

Kenneth D. Steinsapir, MD · Answer

I am providing a link to a blog on this subject. The so-called Botox lip flip supposedly caused the lip edge to turn by using a tiny amount of Botox along the upper lip edge.  If this exists at all (and that is questionable) it is certainly not reproducible. I carefully studied the so-called lip flips on doctor shows and websites.  None of them demonstrated what is described as a Botox lip flip.  Most of them accomplish the "flip" with fillers.  Find an injector who avoid gimmicks and used good technique and a careful eye for doing sensible anatomic treatments.

I had Botox for a “lip flip” and now, 1.5 weeks later, the right side of my smile is crooked. What happened? (photos)

Answers (9)

Answer: Crooked smile? Botox results

Answer: Crooked smile? Botox results

Answer: The so-called botox lip flip is a pr fraud in my opinion.

Answer: The so-called botox lip flip is a pr fraud in my opinion.

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Everything you need to know about Botox

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I had Botox for a “lip flip” and now, 1.5 weeks later, the right side of my smile is crooked. What happened? (photos)

Answers (9)

Answer: Crooked smile? Botox results

Answer: Crooked smile? Botox results

Answer: The so-called botox lip flip is a pr fraud in my opinion.

Answer: The so-called botox lip flip is a pr fraud in my opinion.

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.