Smile asymmetry due to botox for crows feet. Can somebody please give me some advice on what to do? (photo)

Hello,Excellent answer by panel member, Dr. Nelson.  The small amount you were given for the eyes (crow's feet) would wear off much quicker than the negative effects of the Zygomaticus muscle - especially if the product migrated to an unintended muscle.  Unfortunately, only time will improve this as the Botox wears off.

Thank you for your question and post. I am very sorry to hear about your difficulties with your recent treatments of Botox. Seems you had a very minimal amount of Botox injected for the crow's feet and this is normally very superficial in terms of the depth of the injections. It is unlikely that the small amount of Botox you had injected 15weeks ago is behind the symptoms you describe. It is best for your to follow-up with your injector to discuss your concerns as additional investigation may be needed.Sincerely,Dr.Benjamin J. Cousins MDBoard Certified Plastic Surgeon

Hello and thanks for your questions.  Very sorry to hear about your difficulty after Botox treatment.  4 units per side is a very very minimal treatment, that even with maximal migration into the larger muscles of the face/"smile muscles" should not cause any paralysis.  The orbicularis occuli muscles around the eye that are treated for relaxation of the crow's feet lines are very thin, superficial muscles - this is why a very minimal amount of Botox can be utilized to affect change and improve wrinkles by relaxing these muscles.  The larger muscles of the face would most usually not be relaxed by this small amount of Botox.  There is always the possibility that you have a neurologic condition that could require further investigation.  My best advice would be to have a frank discussion with your injecting physician and your primary care physician to come up with a plan.  Best wishes.

It seems that injection under and around the eyes for crow's feet with Botox actually hit the zygomaticus major and caused the drop to occur which affected your smile. there is no antidote for this but it will wear off in a few weeks. The crow's feet returned because that is a more dynamic area and the dose may not have been proper

Thank you for your question and for sharing your
photographs dermo10. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the
upper face. These include the horizontal lines seen on the upper forehead when
one raises the brows, the vertical lines seen between the brows when one frowns
(frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a
formal exam in the office where I can view the skin in multiple angles and
observe wrinkles formed with facial expression, in the absence of consistent photographs before
and after in the same lighting and angles for comparison, and without knowing the dose used and placement of
the product. However I hope the information provided here is useful.The pivotal studies used 24 units of Botox (12
units per side) to address the crow’s feet. These studies demonstrated that the
peak results are seen 14 days after the treatment and most people enjoy their results
for 3-4 months. At that point, a maintenance treatment is recommended. While
some people start to see results as early as the next day, it can take two
weeks for full results so patience is important. We have our patients return two
weeks after their treatment to assess their results via photographs. At that
time additional units may be added if necessary.With any injection, there are risks such as
pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take
special precautions to minimize these risks such as using a painless technique.
We also treat bruises with a laser as early as the next day. Bruises usually
resolve within two weeks if untreated. After a laser treatment bruises usually
resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is
also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles
can lead to side effects such as the temporary appearance of droopy eyelids or
a temporary asymmetric smile. When the crow's feet are treated if the product spreads to the nearby zygomaticus muscles, these muscles can be relaxed. Since these muscles are responsible, in part, for elevating the corners of the mouth when one smiles it can lead to a temporary asymmetric smile. This resolves in 2 weeks to 4 months depending on the severity. If the zygomaticus muscles are relaxed preferentially over the orbicularis oculi muscle, the function of the latter muscle may be restored more quickly, leading to the appearance of crow's feet.In some people the muscle treated for the crow's feet (orbulcularis oculi) is also responsible for holding up the upper cheek fat pad. When relaxed with Botox the fat pad can descend and a hollowing may appear under the eye. This can be addressed by placing fillers such as Volbella in the tear trough.After a Botox treatment, I recommend that my
patients avoid heat exposure, alcohol consumption, and strenuous exercise for
24 hours and not lie down flat for four hours. This is because all of these
activities may possibly lead to the movement of the product and consequent side
effects such as droopy eyelids as described above. Although there have been no
definitive studies shown that these actually occur and some physicians do not
provide such aftercare instructions, in the absence of data I err on the side
of caution and recommend that my patients avoid such activities.A common misconception is that Botox is
only for women. On the contrary, similar to women, many men are concerned about
their appearance and want to look their best. In the past several years Botox
and other cosmetic treatments such as fillers and laser rejuvenation have
become more and more popular in the male population. It is also important to
understand that men have different facial features than women and a masculine
appearance is desired. Therefore, an expert injector should understand the
anatomic differences between the genders and know how to use the product to
produce desired results. One example is the position and shape of the eyebrow.
While the ideal eyebrow for women is high with an arch, men have lower set
brows that are more horizontal. It is critical that the product is placed in
the correct positions on the face to avoid feminizing the eyebrows.Please consult with a doctor for specific
recommendations. Good luck!