Botox injection in cheek resulted in crooked smile & asymmetry. What muscle was affected & when will I see improvement? (photo)

Question

I have been going to a board-certified dermatologist who has done a great job with my botox and fillers in the past. 3.5 weeks ago, I mentioned to her that I had some lip asymmetry, and she injected me twice in my left cheek to correct the underlying muscle imbalance. Now my smile is very crooked. It is lower and more narrow on the left side, and the left corner of my mouth turns down when I smile. Did she hit my zygomaticus muscle or something else? How much longer until I see improvement?

Martin Jugenburg, MD · Answer

Unfortunately you are experiencing asymmetry. Over the next 3 months the Botox will begin to dissipate and your smile will go back to how it was originally.

Mathew A. Plant, MD, FRCSC · Answer

It's tough to say exactly which muscles were affected as they do work as a group. It is possible that it is one of the zygomaticus muscles but could also be your levator anguli oris muscle. Most likely they are all somewhat affected. Botox usually wears off in 3-4 months but the best predictor is how long it has taken your previous Botox sessions to start to lose effect.

Jeffrey Umansky, MD · Answer

Thanks for your question and photos. Sorry to see you are having problems. I think you are correct that your zygomaticus muscle is blocked on the affected side. How long it lasts depends on how much Botox was injected into the muscle. If the Botox just spread to the area it should go away in a couple of weeks. If it was directly injected into the area it may take up to 3 months to resolve. I advise you go back to your practitioner and see if there are any options to help provide symmetry.

Jose Barrera, MD · Answer

It's unfortunate you had a bad experience with Botox injections. Assymetry that you are feeling is likely secondary to placement and dosage. I would followup with the injector and ask specifically about site of placement and the dosage. The effects should last 3 months depending on these factors.

Joseph A. Eviatar, MD, FACS · Answer

As discussed below, sometimes the results from these treatments is not ideal.  However, if you have not revisited your treating physician, I would go back and have them look.  Sometimes, you can improve the result by adding a little botox to the opposing muscle that is over acting and soften the result and improve the symmetry without have to just wait until the botox goes away.  A touch up treatment might be very helpful but check in with your doctor.Best of luck!

Botox injection in cheek resulted in crooked smile & asymmetry. What muscle was affected & when will I see improvement? (photo)

Answers (8)

Answer: Uneven Cheek after Botox

Answer: Uneven Cheek after Botox

Answer: Asymmetry after botox

Answer: Asymmetry after botox

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Botox injection in cheek resulted in crooked smile & asymmetry. What muscle was affected & when will I see improvement? (photo)

Answers (8)

Answer: Uneven Cheek after Botox

Answer: Uneven Cheek after Botox

Answer: Asymmetry after botox

Answer: Asymmetry after botox

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.