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

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.

Doctor Answers 17

Change in smiling after masseter muscle injection with Botox

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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

New York Dermatologist
4.7 out of 5 stars 10 reviews

Botox and Masseter Muscle

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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

Complication of Botox injection into masseter.

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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

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

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This is a strange result for isolated masseter injections. I see patients for second opinion with all sorts of issues following jawline slimming and this typically results from injections outside the masseter muscle that weaken muscles other than the masseter. This should resolve by three months but hopefully sooner. Rest assured, however, that this is temporary. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Masseter injection with smiling problems

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This is caused by the risorius muscle being injected too. This will take up to 3 months to recover. There is nothing which can be done to expedite this.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Masseter Botox Smile Change

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I am sorry about your results and understand your concerns. There is a muscle that lies in the path of your Botox treatment areas close to the masseter clenching muscles called the Risorius that attaches to the corners of your mouth. It was affected by the Botox at the same time as your Masseter. This weakness likely will be worse 2wks after the injections and last 4-6wks. Fortunately it is temporary. I hope this helps.

Botox spread

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Hi there

It seems that your Botox was injected a bit too high or was too dilute and has spread into the zygomaticus muscle that makes us smile. Unfortunately, you are stuck for the time it takes the Botox to wear off to regain your normal smile. Silver lining, the zygomaticus is strong muscle so it shouldn't take too long to counter the Botox.

Stay strong!

Dr M Ganijee

Spread of Botox

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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!


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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.

Ramiro Morales, Jr., MD
Pembroke Pines Plastic Surgeon
4.6 out of 5 stars 28 reviews

Botox and Results -- MASSETER

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

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.