Crooked Smile After Botox® — What to Do

Author

Dr. Stephen Cosentino

Crooked smile is not a side effect of Botox®, exactly. It’s more like an unwelcome complication.

That doesn’t make it any easier to tolerate. Fortunately, this common type of botched Botox procedure is usually temporary. Better yet, it can be reversed before the effects of Botox wear off in three to four months, and without invasive cosmetic surgery.

Learn more about how crooked smile can appear after a Botox injection and what you can do about it.

Crooked Smile After Botox: Why It Happens and What to Do About It

Crooked smile is one of several complications that can occur when Botox is injected in the wrong places (which are often just millimeters away from the “right” places to inject Botox).

Specifically, when Botox is injected into the depressor labii muscle, it can temporarily paralyze that muscle and reduce the patient’s ability to move that side of their mouth. The result is a stiff, fixed expression that can appear “frozen.”

The nearby depressor anguli oris muscle is the “right” place to inject Botox in this case. The depressor anguli oris is a common target for patients who want to reduce the appearance of facial lines and wrinkles around the mouth. Because the two muscles are close by, inexperienced providers often “miss” the depressor anguli oris when attempting to inject it.

Crooked smile can also occur when Botox “migrates” from the initial injection site. Like “missed” injections, migration usually occurs due to provider error. An incorrect injection angle or depth (too shallow or too deep) can send the medication much farther than it’s supposed to travel, affecting nearby muscle groups. In rare but more serious cases, Botox can migrate systemically and cause serious or even life-threatening complications.

Treating Crooked Smile After Botox: Wait or Do Something About It?

The “easiest” way to treat crooked smile after Botox is to do nothing. Because the effects of Botox are temporary, crooked smile usually is as well. Your smile should go back to normal within four months of treatment.

Four months is a long time to walk around with an unnatural-looking smile, though. If you’d like to do something about it sooner, your best option is to schedule another Botox treatment at your earliest convenience.

Crooked Smile Botox Treatment: Using Botox to Fix Crooked Smile

More Botox to treat Botox complications? Is that really a good idea?

Yes — when it’s done properly. Complications like crooked smile are more likely to occur at the hands of poorly trained or inexperienced providers who don’t inject Botox for a living. So be sure to schedule your corrective Botox appointment with a board-certified plastic surgeon, dermatologist, or other medical provider who has completed advanced Botox training with an accredited medical education institution.

The corrective procedure for crooked smile is straightforward. Usually, it requires just a bit more Botox in the depressor anguli oris muscle or targeted Botox injections around the incorrect injection location to “balance out” the asymmetry.

But every patient is different, so your treatment plan may look different. The most important thing to remember is that if you can’t wait, you don’t have to. And don’t settle for a provider you don’t trust.