Am I stuck with this smile for three months post masseter Botox? (Photo)

Question

I have had masseter Botox injected 10 days ago and it's helped me with the clenching but my smile is getting worse by the day. This is all I can manage smiling, the other picture was before. Is this going to resolve? I am so unhappy.

Ramiro Morales, Jr., MD · Answer

Thank you for your question and pictures.  Well the good news is that over the next couple of months this will resolve.  I am not sure why you were having Botox injected into you masseters.  You have a beautiful natural smile so I hope it wasn't for cosmetic reasons.  If for medical reasons, be sure to seek a Board certified doctor who has experience in this.

Jason Emer, MD · Answer

Botox will resolve in 2-4 months. I suggest you see an expert in cosmetic dermatology for future treatments. Best, Dr. Emer

Stephen Prendiville, MD · Answer

Since the masseter is a muscle of mastication and is posterior to and somewhat anatomically isolated from muscles associate with smiling, I am not sure what the root cause of your problem is. Were other areas injected around the mouth injected simultaneously? Secondly, the photos are insufficient to really determine the measure of change that you may see in the mirror.  I encourage you to discuss this with your Doctor

Nelson Castillo, MD · Answer

Thank you for your question and for sharing your photographs.  I see your area of concern for your smile but I would allow a couple of more days to pass to allow the Botox to fully mature.  There can be subtle changes in the 10-14 day range after treatment.  If there is little improvement in appearance one of the muscles responsible for fully elevating your upper lip was partially affected and will need time to return to normal.  This may take several weeks.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question finallysophia. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. In the lower face Botox can be placed in the masseter to help shape the face or to address clenching of the teeth. If the Botox spreads to the nearby risorious or zygomaticus major or minor muscles, a temporary asymmetric smile may result. Most people enjoy their results for 3-4 months. At that time the face should be back to baseline. Please follow up with your doctor for specific recommendations. Good luck!

Sheryl D. Clark, MD, FAAD · Answer

Dear finallySophia:The risorius muscle lays anterior and superior to the masseter muscle. If Botox was injected more anterioriorly or superiority than usual, especially if a dilute concentration was used, the risorius muscle can relax as well or instead of the masseter muscle. This muscle inserts into a fascial plexus called the modiolus just to the side of the corner of your mouth, and is responsible for drawing your lips to the side, to create the wide or sardonic smile.Fortunately, this effect will peak at 2 weeks and then slowly wear off in a few weeks to several months, depending upon the amount of Botox that reached the risorius muscle. You should still be able to create a genuine smile, since the zygomaticus major and minor muscles are responsible for the real smile that also crinkles the eyes. This effect can be avoided by using Botox in a concentration of 100 units per ml, placing the injections low and posterior, into the mass of the masseter itself (easy to feel by asking the patient to clench their teeth, grasping the muscle that pops out, and injecting into the largest portion of it in a triangular pattern) and not deep to the parotid gland.I am sorry you have to endure this rare side effect. But it will wear off and should not happen again.All the best,Dr. Clark

Michele S. Green, MD · Answer

It sounds as if one of the nerves that affects your smile was inadvertently injected with the masseter muscle.  It will wear off in 4 months. Please consult an expert for the best cosmetic results.  Best, Dr. Green

Steven Wallach, MD · Answer

This could be from an injection of Botox away from the master affecting another set of muscles that aid in smiling. If this is the case, it will resolve in 3-4 months.

Shaun Patel, MD · Answer

Sorry to hear about your issue with Botox injection. It appears that the physician who injected your masseter may have injected a little to anteriorly and so the Botox spread into the risorious muscle. That is almost certainly why you have an altered smile. Nonetheless, the Botox effect will wear off with time (approximately 3 months). Some physicians might consider injecting your other risorious to balance out the smile but I would probably wait for the Botox effect to just wear off. This is a rare complication of Botox injection into the masseters. I would hope you continue to get the injections because it really does help with the clenching/grinding. -Dr. Patel

Peter H. Grossman, MD, FACS · Answer

Hi,
thank you for your questions and photos. Unfortunately, Botox takes about 3
months to wear off. Fortunately, it IS temporary. Unlike fillers, there isn’t
any sort of dissolving or correcting agent that can reverse the effects of your
Botox treatment. Be patient and it will resolve itself with time. Best of luck
to you.

Am I stuck with this smile for three months post masseter Botox? (Photo)

Answers (16)

More Botox Questions

Botox in orbicularis Oculi: bags!! What can I do? (photos)

How often should masseter Botox be redone?

Is there any problems to have a cosmetic Botox treatment taking methotrexate 2.5mg?

Huge Mentalist muscle. Any suggestions? (photos)

I rubbed my eyebrow after Botox. What are the chances I will experience a bad effect from this?

WE SEND PRETTY
EMAILS