My mouth has become asymmetric following Botox treatment. Is this fixable? (Photos)

Question

Or will I have to wait for it to wear off? I had Botox injected in between the brows, in the crow's foot regions and in my chin. The left side of my upper lip has been affected, and you can see how much flatter it is than the right side.

David Yew, MD · Answer

I'm sorry that you are experiencing this unfavorable result.  This is a temporary effect and will last several months but eventually everything will resolve 100%.    It appears from your photo that it was from the aggressive placement of botox in your left crow's feet resulting in the zygomaticus major muscle being affected.  The other possibility is if the injector placed botox too medially on the chin and accidentally involved the DLI muscle from the DAO injection.   In either event - I suggest you go back to the doctor and ask him to either correct it (which should be done by someone who is highly skilled) or ask for a refund.  This is due to placement error on the injector's part.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  Unfortunately the best course of action will be to allow the results of your Botox to wear off.  One of your crow's feet injections affected a muscle responsible for elevating your lip and until this wears off your smile will remain unbalanced.  Hang in there.

Kenneth Yu, MD · Answer

Hello.  I'm sorry to hear about your results.  The good news is Botox will wear off in 3-4 months (rarely 6 months), but guaranteed it will be gone by one year.  I highly recommend you follow up with your injector so he/she can adjust the technique next time.  Take care

Ramandeep Sidhu, MD · Answer

Sorry to hear you had issues with botox. These are usually because of botox being injected either too much or at wrong location and it can happen with any injector. Two options: let it wear down and you will be surprised how quick this will wear out if it is a trickle effect. Other option is to balance the effect but that can lower your upper lip but will be worth discussing with your injector. 
Good luck.

Kenneth D. Steinsapir, MD · Answer

It is tempting. Your doctor may want to do this for you.  However, my advise is to let this treatment wear off and never get botox in the chin (or perhaps any area) from this injector.  It will wear off but it will take time.

Daniel Barrett, MD · Answer

Dear LondonStargazer,Botox is generally an on off switch for muscle activity. Most of patients see first changes after 4-7 days and the final results after 10-14 days. It depends on the amount of Botox and area where it is injected but it usually last for 3-4 months.If you are concerned, you can consult your injector.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. It might be possible to even out your mouth area with additional Botox, but could make matters worse. From the photo, it doesn't look bad. I would consider waiting until the problem resolves before doing anything. Good luck,

Summit Kundaria, MD · Answer

Thank you for the question and pictures.   Your face should return back to it's pre-Botox state in 3-6 months.  I have a feeling that it will be earlier than this, as the mouth asymmetry is due to the neurotoxin migrating to an area it was presumably not injected, so there is less material giving you the "side effect" compared to the "effect".  Good luck!

Lisa Freeman, MBBS · Answer

Thanks for your question. If this asymmetry occurred about 5 to 14 days after your botox injections, it is most likely due to  botox. Botox injected into your crows feet must have been inadvertently injected into a muscle that lifts the corner of the mouth, and thus has paralysed that function on the affected side. The good news is that it is temporary and the function will fully return once the botox wears off, which could take a few months. Follow it up with your doctor. Good luck.

C. Jeff Kesler, MD · Answer

Thank you for submitting your question. Facial asymmetries can occur with injection of Botox. It appears you may have had some crows feet or malar area ejection that is affecting your facial symmetry. The good news is that all Botox is temporary. I would not recommend any aggressive treatment for this. I would simply let the injection wear off until you regain your symmetry. I have never seen permanent effects from Botox.
Best of luck!
Dr. K

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