Botox in the chin gave me lopsided smile ;( Help! (photo)

Question

I had Botox done 7 days ago to get an eyebrow lift while I was there, the doctor put some in my chin. I don't know whether she put too much or in the wrong muscle - k am now left with lopsided smile. She said she put 6/7units in total. My smile is gone and it's leading upto Xmas time. Wanted to know how long 7units of Botox will last around the chin area?? Doctor said to me during my follow up that if I use my muscle more and have galvanic facial this will help reduce the effects of Botox. Do you agree?

Jason Emer, MD · Answer

Botox lasts about 3-4 months. In the mean time, thermage/venus legacy can help reduce this. See an expert. Best, Dr. Emer.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph beautyfreak. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.Although Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the mentalis muscle on the chin to address a cobblestone appearance or dimpling on the chin. In this area 2-8 units of Botox are used.In the lower face, the depressor labii inferioris (DLI) muscle sits between the mentalis and the depressor anguli oris (DAO) muscles. The DLI muscle is responsible for pulling down the lower lip and it is used when one smiles. If Botox spreads from either the DAO or mentalis to the DLI and relaxes the DLI it can lead to the appearance of an asymmetric smile. Some physicians try to correct it by placing Botox into the contralateral DLI muscle (on the other side). However, I recommend that my patients just wait as the effects go away on their own. This side effect resolves on its own in 2 weeks to 4 months, depending on the severity. Some find that laser skin tightening treatments using infrared light or radiofrequency may speed up the resolution process.If I had a patient with the concern described her I would recommend any of the above including infrared light, radiofrequency, or galvanic facial.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.
  
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. 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.
    
Please consult with a doctor for specific recommendations. Good luck!

Ravi Jain, MBBS · Answer

When treating the lower face with Botox type injections it is important to understand that risks of unwanted outcomes is higher than when treating the upper face because of the local anatomy. It may be possible to even out the smile by relaxing the unaffected muscle so that it matches the affected side. This may sound strange but it often delivers an even smile and a much happier patient!

Otherwise, if its not too bad, just wait for the effects to wear off which could be anything between 3-12 weeks.

Otherwise, if its not too bad, just wait for the effects to wear off which could be anything between 3-12 weeks.

Remus Repta, MD · Answer

Thank you for your question and photo.  The positive side to your dilemma is Botox placed around the mouth tends to wear off more quickly because we use those muscles so often with talking and eating.  I would definitely support you working the muscles and if you can expose yourself to heat, as with hot yoga or a sauna on a regular basis, you will metabolize the Botox more quickly, too.  You will probably notice a return to your normal self rather quickly.  Just communicate with your injector that you may want to avoid having Botox injected in the depressor anglularis muscle in the future.  Wishing you so well on your journey!

Renata Wix-Harris, MD · Answer

It looks like the Botox accidentally affected the muscle that normally pulls down the right side of your lower lip because of incorrect placement of the Botox. The bad news is that there is not much you can do at this point. You can try to correct the asymmetry by placing some Botox on the left side to create the same effect, but it may give you problems with eating, drinking and speaking. The good news is that it will wear of in about 3 months. Good luck.

Jordan P. Farkas, MD · Answer

Hi-  It looks like you may have had your depressor angularis injected which would cause that asymmetry. It will soften after 8-12 weeks time. Unfortunately the Botox is doing exactly as it should do by weakening that muscle and causing that asymmetric appearance. However, the benefit and curse of Botox is that it is temporary. Hang in there.

Steven F. Weiner, MD · Answer

This will just have to wear off. It affected you DLI muscles. There is nothing to do to make it wear off faster.

Melvin Elson, MD · Answer

it usually takes 8 units to do the browlift so you had a very small amount of toxin.  if the smile does not get better over the next week you can have it corrected with correct placement of more Botox

Edwin Ishoo, MD · Answer

Botox is used to weaken or paralyze muscles. It is doing its job, unfortunately the injection was not placed properly. If the asymmetry is due to Botox, it will likely last around 10 weeks and unlikely that anything would speed up recovery significantly.

Botox in the chin gave me lopsided smile ;( Help! (photo)

Answers (9)

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