Uneven asymmetrical outcome from Botox in masseters? (Photo)

Hi there,It sounds like the asymmetry you are describing may be the result of your injector hitting a muscle called your risorious. The risorious attaches in the masseter muscle and if Botox is unintentionally injected into it, or diffuses into it, the result is an asymmetrical smile. Botox takes up to two weeks for full effect. The buldging may be due to the more superficial aspects of the masseter being injected and not the deeper aspect of the muscle. Masseter injection must be deep. In my professional opinion, 10 units per side is not a large enough dose, however it is difficult to definitely say so without assessing you in person. 20-40units per side is more accurate for first time injection if the masseter muscles, dose will vary between individuals. Atrophy of the muscle takes time- just because the Botox has taken full effect does not necessarily mean you will see results. It can take months for the muscle to shrink and slimming to be noticeable.

Your question is difficult to answer without pictures, but it seems that the Botox was incorrectly placed and is now affecting the muscles involved with your smile. It can take up to 2 weeks to see the full results from Botox, but your smile likely won't get better until the Botox wears off in 3-4 months. I would recommend you follow up with your injecting physician. If you don't feel comfortable with him/her then find someone you feel more comfortable with. Best wishes.

Hello Cranberrywhirl.  Thank you for your question.  Botox takes longer in the lower face to fully "take."  Wait a full two weeks before being concerned with asymmetry.  Your masseter muscles will not atrophy with one dose of Botox.  This would only occur over continued injections over the course of at least  a year.  The slimming look from injecting masseters is due to not being able to clench that muscle so tightly.  Botox in the lower face usually only lasts for about 2 months because the constant movement tends to kick the Botox off the nerve receptor sites quicker.  I hope this helps with your question.

Thank you for your question, I understand your concern.  Although the effects of Botox can begin to kick in around day 3-5, it takes a full 2 weeks for Botox to reach full effect. However, the slimming effects can take up to 30 days to see, as the muscles requires time to atrophy (decrease in size). The appropriate dose for masseter treatment varies patient to patient depending on the size and strength of the patient's masseters. 
Once the effects of Botox wear off, the muscle will begin to function more frequently and regain its strength, slowly increasing in size again, which is why I recommend treatments every 6 months initially. Many patients report that with time they need treatments less frequently. 
Without photos it is hard to tell if your asymmetrical smile is due to Botox injections into your masseters or chin. With both of these areas there is a risk of affecting your smile. I recommend seeing an injector with extensive knowledge of facial anatomy. 

I suggest you wait 2 weeks to assess the asymmetry you are seeing.  The Botox may not be in full effect at 7 days, and sometimes appears to be uneven until that
Dosing requires an in person assessment by a doctor.  The most common dosing for a masseter reduction is around 30 units on each side.  If properly dosed, you can expect to see a change in the size of the masseter at about 6 weeks.

Your question is difficult to answer without pictures, but it seems that the Botox was incorrectly placed and is now affecting the muscles involved with your smile. It can take up to 2 weeks to see the full results from Botox, but your smile likely won't get better until the Botox wears off in 3-4 months. I would recommend you follow up with your injecting physician. If you don't feel comfortable with him/her then find someone you feel more comfortable with. 

Hello cranberrywhirl,
At 7 days there is still a chance that the botox is kicking in in your muscles at slightly different rates, and I recommend to wait until closer to 10-14 days before considering any adjustments. With an asymmetrical smile, the botox likely diffused into perioral muscles that affect your smile. Depending on the appearance of your smile, it is possible to adjust the symmetry of your smile with additional botox, though it may be best to wait for the effects of the toxin to lessen as an additional injection could also worsen the asymmetry. Botox does not usually cause atrophy (atrophy is loss of muscle mass), but instead temporarily weakens a muscle. Because of this, you may begin to notice an improvement in several weeks, and most of the toxin should be worn off around 3 months. I recommend waiting it out, especially since you received a fairly small dose. I hope this helps, and good luck!

First of all you had an extremely small dose but the uneveness of the smile is because the injection was too close to the mouth on one side and to avoid this there is an alternative method of treatment that involves only 3 sites instead of 5,  see a board certified dermatologist

Thank you for your question. It's difficult to comment without a photo as you had injections into pretty difficult areas of the lower face and they both can lead to facial asymmetry if Botox affects near by muscles as well.  It can easily happen with chin or masseter.  The fact that you only had 15 units injected into your jawline is a huge surprise at it is a significant underdosing amount.   Botox never causes any muscle atrophy, it is simply a muscle relaxant.  I'm sorry to hear that you have such a result, but it can happen to anyone, even with the best experts, however, you need to be seen for a follow up as any expert can fix the uneven smile. The good thing is that botox effect is temporary.  If it's from your jaw line, they results last 6 months if the correct dosage was achieved, you were significantly underdosed, so you will regain your movement much sooner, it coulee in the next few weeks. You can wait another week as it does take up to 14 full days for botox to take it's full effect, but I believe it will not change. Please discuss the treatment plan with your doctor to figure out what to do next.  I would advise to wait for the effects to completely wear off before attempting to reinject and start with masseters only, no chin.  On average, the Botox dose is 40 units ( both masseters) and can go up to 100 units easily, it all depends on how strong and big your muscle is. It's not the same universal dose for everyone and requires close follow up to determine the best dosing. Hope this helps, Best, Dr.Avaliani

Personally I believe that injecting Botox into the chin is a huge mistake for the majority of individuals. It almost always results in an asymmetric facial expressions and smiling. Botox is not going to result in atrophy of your masseter muscles because this muscle is extremely strong and after a while of not receiving botox it will come back to its pretreatment size. Before receiving your treatment, make sure you speak to your plastic surgeon or dermatologist about what to expect and how to proceed with the treatment to get the best outcome possible. Good luck from New York City