Masseter Botox gone wrong (Photo)

Question

3 months ago I received Botox in my masseters for TMJ. It was my 2nd time, same provider, my ENT doctor. First time we did 20 units per side as I wanted to be conservative, however it did not help much. A couple months later, he did 30 more units per side. My right side looks fine but left side looks horrible. It migrated to one of my smile muscles. I now have a dent in my cheek and lots of new wrinkles near my eye. I get married in April and am terrified it won’t be back to normal. Pls advise

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about your experience. Here are some options and advice that might help address the situation:

1. Time and Patience:

Botox effects are temporary, typically lasting 3 to 6 months. The asymmetry and any unintended effects should gradually improve as the Botox wears off.
2. Consultation with a Specialist:

Consider consulting with a board-certified dermatologist or a plastic surgeon who specializes in facial aesthetics. They can assess your situation and provide targeted advice.
3. Hyaluronic Acid Fillers:

If the dent in your cheek is significant, a skilled injector might use hyaluronic acid fillers to temporarily balance the asymmetry. This can help improve your appearance for your upcoming wedding.
4. Neuromodulator Adjustment:

In some cases, a professional might be able to adjust the balance by strategically injecting additional Botox in other areas to even out the muscle activity, though this requires careful evaluation.
5. Skin Care and Makeup:

Invest in a good skincare regimen to improve skin texture and elasticity. Professional makeup techniques can also help camouflage asymmetry and wrinkles for your wedding day.
6. Facial Exercises:

Some patients find that gentle facial exercises can help improve muscle tone and symmetry over time, though this should be done cautiously and ideally under professional guidance.
7. Stress Management:

Try to manage stress, as it can exacerbate TMJ symptoms. Techniques such as meditation, yoga, or relaxation exercises might be beneficial.
It's understandable to be concerned, especially with your wedding approaching, but working closely with a skilled professional can help you find the best interim solutions. If you have further questions or need additional help, feel free to reach out.

Eric M. Joseph, MD · Answer

We have seen asymmetrical smiles after masseteric Botox many times, and you do not appear to have a significant problem. I do see the bulge in indentation that you're talking about when you smile, however, the rest of the world will not see this. And always remember: Results of Botox are completely temporary. Eventually your normal smile will come back with certainty. Gratulations! Sincerely, Dr Joseph

YeahSmile - Cancun - Account Suspended · Answer

I'm sorry you're experiencing these concerns with your Botox treatment. Here’s some information and advice to help you:
1- Botox Migration and Smile Asymmetry: It seems that some of the Botox injected into your masseter muscle may have diffused into adjacent muscles, possibly affecting the zygomaticus (a muscle involved in smiling). This can result in asymmetry, a cheek "dent," and changes to facial expressions.
2- Duration of Effect: Botox effects typically last 3-6 months, with most people starting to regain muscle function around the 3-month mark. Since your treatment was done 3 months ago, you should start seeing gradual improvement in the coming weeks. The full return to normal may take a bit longer, but by April (your wedding), it’s likely to be significantly improved.
3- Addressing Wrinkles and Asymmetry in the Meantime: - Facial Exercises: Gentle facial exercises might help stimulate the affected muscles to regain function sooner, though results can vary. Your doctor or a physical therapist experienced in facial muscles can guide you. - Filler or Temporary Enhancements: Some providers may recommend temporary fillers or treatments to address the cheek dent or wrinkles. However, proceed cautiously to avoid further complications.
4- Consultation with an Expert: Since you’re concerned about this and have an important event (your wedding), consider consulting with a dermatologist or plastic surgeon who specializes in Botox and facial anatomy. They can evaluate the area and suggest treatments that might help accelerate recovery or camouflage the effects temporarily.
5- Future Treatments: For future Botox treatments, inform your provider of this experience. A smaller dose or injections placed more precisely may help avoid migration and asymmetry.
It’s understandable to feel anxious, but with time and possibly some expert advice, you’ll likely see improvement well before your wedding.
Dr. Miller Vieira Paula

Kurt Kuhlman, DO · Answer

This can happen with Botox injected to the Masseter muscles. The risoroius and Zygomaticus  muscles can inadvertently be injected usually because the injector was too medial and too superficial with the injection.
Fortunately, it will recover by 6 months so you will be fine by your April wedding.

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