Cosmetic Surgery Tips

Can Botox be used to treat an asymmetrical smile?

Have you ever had an asymmetric, crooked, or uneven smile after a Botox treatment? This is a rare side effect. Keep reading to learn more.

In this guide, we find out the following: Can Botox be used to treat an asymmetrical smile, crooked smile after masseter botox, Where do you inject Botox to fix uneven smile, and How do you fix an asymmetric smile?

Botox is a purified protein used to treat wrinkles caused by facial expression. Botox works by relaxing muscles, which smoothens out your wrinkles.

Botox can be used on many areas. Botox is best known for treating frown lines between your eyebrows, horizontal forehead wrinkles, and crow’s feet around your eyes. But Botox can also be used for a gummy smile, lip flip, lifting the corners of your mouth, chin wrinkles, and slimming your lower face.

Botox works by relaxing muscles you use to make facial expressions. One facial expression you don’t want to have affected is your smile. You have many muscles around your mouth that you use to smile. The zygomatic major and minor muscles pull the corners of your mouth up and out. The LLSAN (levator labii superioris aleque nasii) muscle pulls you upper lip upward. The risorius muscle pulls the corners of your mouth our towards your ears. And the depressor labii inferioris (DLI) muscle pulls down your lower lip, and you have one of these muscles on each side. When Botox spreads to any of these muscles, it will relax them. Usually this only happens on one side. This makes your smile on that side look different.

When treating your crow’s feet, if the lowest Botox injection is placed too deep, it can affect the zygomaticus muscles. This will make it hard to lift and pull out the corner of your mouth on the affected side. If the Botox spreads when treating your bunny lines or when doing a lip flip, it can spread to the LLSAN muscle. When this happens, you have trouble lifting your upper lip on that side. Botox can be placed in the masseter muscle (the primary muscle you use to chew) to relax it and slim the lower face. If the Botox is placed too superficial or too close to the mouth, it can spread and affect the risorius muscle. This will make it harder to pull the corner of your mouth out toward your ear on the affected side. Botox can also be placed in a muscle called the DAO (depressor anguli oris), which pulls down the corners of your mouth. This will lift the corners of your mouth and decrease a sad face appearance. If it spreads from this muscle, or from the mentalis muscle targeted for chin wrinkles, it can affect the DLI muscle. This will make it harder to pull down your lower lip on the affected side.

Obviously having an abnormal smile is not desirable. Some people say it looks like you’ve had a stroke. Therefore, it’s important to have your Botox treatment by an injector with experience to avoid this side effect and other side effects such as droopy eyelids or blurred vision. Also, after your Botox treatment be sure to avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours after your Botox treatment. And avoid bending forward or lying flat by staying upright for four hours after your Botox treatment. Doing any of these things can increase the likelihood of spreading the Botox to other muscles, which causes side effects.

Fortunately, the effects of Botox are temporary, including side effects such as an asymmetric, crooked, or uneven smile. Most people enjoy the intended effects of Botox for three to four months. This is when the Botox is placed directly into the muscle it is intended to relax. When the Botox spreads to nearby muscles, usually only a little bit of the Botox spreads. So the side effects normally don’t last the full three to four months. Side effects such as an asymmetric smile usually go away on their own within two to four weeks.

Although side effects such as an asymmetric smile usually go away on their own, you can speed it up with infrared lasers or radiofrequency. Dr. Alex can perform a laser skin tightening treatment on the area. This uses gently micro-pulses of infrared light to slowly and gently heat the skin. This brings blood flow to the area and stimulates the muscles. This can be done multiple times if necessary.

crooked smile after masseter botox

Ever met someone and wondered whether there was something wrong with the way they look- a little too much Botox perhaps? Stiff looking forehead or tight looking facial expressions. Or it could be that they’re looking like Captain Spock or asymmetry in their faces that didn’t use to be there. If you’re noticing any of these signs- it could be a case of Botox gone wrong with too much Botox injections.

In this blogpost, let’s take a closer look at real life examples of Botox gone bad- and how you can avoid becoming a classic tale of too much Botox. Don’t get me wrong; Botox is a very useful and effective drug for treating numerous medical conditions, including wrinkles and bruxism. I’m a personal fan of Botox injections for my own wrinkle removal as well! If you’ve been reading this blog, you’d probably know by now that I’m an advocate of natural looking results for aesthetic enhancement. So that means being conservative with small doses of Botox and/or fillers to restore signs of youth; without looking overdone, aka Baby Botox.

Botox is one of the brand names for Botulinum toxin, a drug that causes muscle relaxation. As Botox was the first brand of Botulinum toxin that was made commercially available. As such, Botox remains the biggest market player among brands of Botulinum toxin. As such, the brand name Botox is sometimes used interchangeably with the drug name, Botulinum toxin.

When injected into muscles, Botulinum toxin inhibits signal transmission from nerves to muscles. This results in muscle relaxation. Since these muscles (e.g. forehead muscles or crows feet) are relaxed, the muscles and skin soften and the wrinkles disappear. Using Botulinum toxin to relax muscles also helps with medical conditions such as bruxism to reduce teeth grinding and protect the teeth.

Although Botox is a very useful drug for treating several medical conditions, many people are still skeptical about receiving Botox injections for fear of side effects and complications. To learn more about the safety issues; and long and short term side effects of Botulinum toxin injections, this blogpost Is Botox Deadly? 5 Things to Know About Botox Safety will discuss these essentials in greater detail.

Too Much Botox: Botox Injections Gone Wrong

Are you ready for some real life examples of bad Botox and how you can guess if someone’s had too much botox? Here are some examples of Botox gone wrong and how these examples of botched botox can be fixed.

Nicole Kidman has been candid about receiving cosmetic work to her face, including Botox injections. At least she did not attribute her wrinkle free face to olive oil

The first image that comes to mind for most of us would be… the frozen face. There are no lack of examples when it comes to this: odd, expressionless looking faces; and stiff, unmoving forehead muscles and smiles. One celebrity whose appearance has been the subject of media scrutiny for years is Nicole Kidman. The Hollywood actress has admitted to receiving Botox injections in 2013.The 53 year old thespian is back in the spotlight again for her tight looking and frozen facial expressions in emotional scenes in her new drama, The Undoing.

Tom Cruise: Frozen in time thanks to botox?

Men are not privy to the faux pas of excessive botox injections too. Tom Cruise has also sparked speculation about having botched botox because of his shiny, unmoving forehead.

How can a frozen and expressionless face from Botulinum toxin injections be avoided?

Thankfully, the effects of Botulinum toxin wear off within 6 months so a paralysed face from Botox is always temporary. However, you can get your wrinkles removed without a frozen face in the first place by choosing to do Baby Botox.

Baby Botox is one of the newer methods for administering botulinum toxin in small amounts and at precise anatomy. This gets the balance of good results (i.e. wrinkles removed) and natural outcomes (i.e. facial expressions are left intact, so you can still smile and frown…etc). You’ll look more refreshed and less tired with Baby Botox. I’m a personal fan of Baby Botox for my own forehead and crows’ feet wrinkles. You can take a look at my before/ after photos of Baby Botox I gave to myself (job perks!) in this blogpost Baby Botox and Preventive Botox in Your 20’s Is Real.

Secondly, if you get Botox for wrinkle removal regularly (I’m one of them too; I get so conscious of my wrinkles!); avoid getting it done too soon. The results of Botulinum toxin last 4-6 months for most people. If Botulinum toxin injections for wrinkles are repeated too early; the effects of muscle relaxation are compounded to freeze the muscles completely. If you’ve been getting Botox injections regularly, you might find these posts How to Make Botox Last Longer and What are the Effects of Long Term Botox useful.

Melanie B aka Crazy Spice’s transformation from the late 90’s to today. Note how her her eyebow arch has changed.

Spock Brow

An overarched brow ala Captain Spock from Star Trek is one of the outcomes of too much forehead botox; just one degree shy of a frozen forehead. What has happened is that inappropriate placement Botulinum toxin has caused the tail of the eyebrow to look pulled.

There are more than one causes of spock brow; eyebrow embroidery or tattoos are also one cause of over arched brows. One tip to know whether Botulinum toxin has contributed to their spock brow is to look closely at their forehead movements.

How can Spock Brow after Forehead Botox be prevented or treated?

For this, you’re going to choose your doctor carefully because it boils down to understanding facial anatomy to prevent this from happening in the first place. However, if you already have arched or angry looking brows after forehead botox, it can be corrected! A small amount of Botox to reduce the pull of the frontalis muscle on this high arch is all that is needed.

Spock brows alert! Nicole Kidman at it again.

Masseter Botox and Weakness in Chewing

Jaw botox injections is one of the treatments for bruxism (teeth grinding). By relaxing the masseter muscles with Botulinum toxin, teeth clenching or grinding is reduced. Masseter botox injections also slims down bulky jaw muscles for a slimmer and symmetrical silhouette. If the dosage of Botulinum toxin injected into the masseter muscles is too large, there may be weakness or difficulty in chewing.

Bruxism: Causes, Symptoms and Treatments for Teeth Grinding

The risk of masseter botox gone wrong and affecting bite or chewing in reality is very low. Can you guess why? This is because all of us have four different muscles that control the chewing action of the jaw. The three other muscles remain functional if only Botox was injected into the masseter muscle.

How can weakness in chewing be prevented with jaw botox?

Quite simply, the answer is not to overdose on Botox for the jaw muscles. With jaw botox, it’s about striking a good balance between reducing bruxism (and slimming down the muscle) and preserving the ability to chew and bite normally. For some patients, who notice that they are still grinding their teeth or that their face still looks broad- they may require a combination of other treatments on top of jaw botox. This may mean using a night guard or chin fillers to sculpt the face. You can read about how chin fillers can be combined with masseter botox to improve facial proportions in this blogpost A Guide to Slimmer V Face: Jaw Reduction Botox and Chin Filler Review.

Masseter botox injections relax the jaw muscles to create a slimmer face shape and defined jawline.

Masseter Botox and Crooked Smile

Masseter botox causing a crooked smile is one of the rare risks of jaw botox. However this side effect may not be caused by an excessive dose of jaw botox. When botulinum toxin is injected into any area of the body, the toxin has a risk of diffusing into surrounding muscles. This may be accentuated by certain actions or habits after the injections. Where jaw botox is concerned, botulinum toxin may inadvertently diffuse to a nearby muscle that controls the smile (depressor anguli oris). If this muscle gets affected, a crooked smile may result after jaw botox.

How can a crooked smile be avoided after jaw botox?

To minimise the risk of neurotoxin diffusing to surrounding muscles; it is pertinent that post treatment instructions from your doctor are adhered to strictly. For Botox, one of the instructions would to always stay upright for the first 4 hours after receiving the injection. If you were to lie down, the botulinum toxin injected into your muscle may move in a different direction.

Another drastic transformation from Simon Cowell. Besides forehead and crows’ feet botox, he is very likely to have also undergone a face lift.

And there you have it- the tell tale signs of too much Botox injections. The classic frozen faces or weird expressions are some of the giveaways. To avoid becoming a disaster of bad Botox, my general tip is to go gentle with smaller doses of Botox, especially if you are new to getting neurotoxins or aesthetic treatments. Afterall, it is easier to add on more Botox later than to wait out the effects of too much Botox. My last tip would be to choose a doctor whose treatment philosophies are in line with yours and who can help you better understand anticipated outcomes.

I hope that you have enjoyed this blogpost on bad botox. If you’d like to learn about bad examples of dermal fillers, Too Much Fillers: Tell Tale Signs of Too Much Filler Injections is another fun read!

Ending off this blogpost with a satire on excessive Botox, fillers and cosmetic surgery from pop star, The Weeknd. In his “Save Your Tears” music video, he wore prosthetics to create this look! Thank goodness if was not for real!

Where do you inject Botox to fix uneven smile

A beautiful smile has become a symbol of health, happiness, and, simply, beauty. Teeth-whitening companies have proliferated over the last decade, as has the popularity of cosmetic dentists, dental treatments, and related products.

One aspect of a beautiful smile is consistently overlooked, and that is the impact of an asymmetrical smile. Many people are self-conscious of their smile because it is asymmetrical, gummy, or uneven.

These people may go so far as to avoid social situations, cover their mouths with their hands, avoid smiling at all, or will constantly look down or purse their lips.

The surgical correction of a lopsided smile may not be an option for some, due to its high cost or possibly because they want to avoid surgery. Many people don’t even realize that there may be a solution to their problem.

Although the man on the street with a normal smile may never think about this issue, aesthetic surgeons should watch for it. However, we may overlook it because we just aren’t looking for it. To make matters worse, the patient may not mention it because she is unaware of the fact that her lopsided smile could be corrected by a simple injection of botulinum toxin Type A.


I treated a patient a few months ago for lip enhancement. Once given Restylane and pleased with the result, she left the office. During the injection, she commented that she had uneven lips and that they may be difficult to even out because of their shape.

A few years before her visit, she was in a motor vehicle accident that affected the innervation of her lips, so that one side was weaker than the other. Her smile was now lopsided. She simply couldn’t elevate the right side of her lip normally when smiling. Even when she was at rest, her defect could be clearly seen.

A few days after she received the Restylane lip enhancement, her son called to say that the lip enhancement had brought more attention to her asymmetrical smile. Her son wanted to know if anything could be done about it.

After carefully examining her in my office, I determined that the defect was a weakened upper lip elevator on her right side. The upper lip elevators include the levator labii superioris, the levator labii superioris alaeque nasi, the Zygomaticus major and minor, the levator anguli oris, and the Risorius.


I administered two units of botulinum toxin Type A into the body of the left levator labii superioris muscle. I placed this injection around 1 cm below the orbital rim near the ocular foramen, near the origin of the muscle.

The midline depressor septi muscle also plays a role in lip elevation. When determining which muscle was affecting her lip asymmetry, I watched her smile carefully to ascertain, as closely as possible, which muscle group was involved.

Many different lip asymmetries exist. They may involve the lip elevators or lip depressors. Careful evaluation and knowledge of lip anatomy and muscle function must be carried out prior to injection.

The muscle’s course should be outlined so that the correct muscle group is targeted. The injection must also be placed where it will not migrate to other muscle groups, which would result in too much lip elevation or depression—or worse, give the patient a completely different asymmetry.

Once identified and isolated, the muscle should be injected with as small amount of botulinum toxin Type A as possible to see if the correct elevator or depressor has been found and to avoid overcorrection of the defect.

I dilute my botulinum toxin Type A with 1 cc of preserved saline, which gives me increased control over the amount injected.

I injected two units of botulinum toxin Type A directly into the patient’s muscle and achieved perfect balance of her smile. I suggest that most often one should start with just one unit, wait a week or so, and then see the patient again and confirm the effect of the injection.

This way, if the wrong muscle group was targeted or the muscle was not injected in the best location, not much harm is done. You can either wait until the botulinum toxin Type A wears off, or try to pinpoint the injection site more precisely and try again.


Many patients will present you with an asymmetrical smile due to an imbalance of the lip depressors. However, one of this patient’s lip elevators was weak. Ask the patient to maneuver his or her lips into several facial expressions to help to identify the muscles involved. This way, you can more precisely achieve your intended aesthetic goal.

The proper relaxation or balancing of the antagonistic muscles of the lip elevators and depressors will help you gain profound improvements in the patient’s appearance.

At around that same time that the asymmetrical-smile patient presented, my nurse approached me about her gummy smile with the hope that I could also help her. When she smiled, a disproportionate amount of gum showed. She admitted to feeling self-conscious when she smiled, and, as a result, was often reluctant to do so.

This is a separate and different problem from the asymmetrical smile discussed above, but it is just as embarrassing to the patient. Again, careful assessment of the affected smile will allow you to target the muscle, select the proper treatment, and determine the correct amount of botulinum toxin Type A to administer to weaken the muscles responsible for this unattractive exposure of gum.

I encourage all physicians who perform botulinum toxin Type A injections to look out for these problems. Correction will bring great pleasure and satisfaction to your patients and could offer them a tremendous improvement to their lifestyles.

How do you fix an asymmetric smile?

Is your smile unbalanced? Perhaps your gums are uneven. Maybe your teeth are not uniform. There are many reasons why you may have a crooked smile. At Metropolitan Dental Care, our Lone Tree dentists offer a variety of cosmetic treatments to bring balance and beauty to your grin. No matter your goals, your cosmetic dentist can design a personalized treatment plan to deliver the look you desire.

Sometimes, it can be difficult to pinpoint exactly what you dislike about your smile. You may be able to tell something is slightly off, but you may not know what it is. The most common reasons for a crooked smile are:

Ideally, the gums serve as a framework for your smile. They should accentuate your appearance, but never become the sole focal point. If your gums are creating an asymmetrical smile, our doctors can perform a gum contouring procedure – also called a smile lift. By gently removing excess gum tissue and reshaping the gingival margins, you can enjoy a beautiful and balanced look. This treatment can be completed with the use of a soft diode laser, which gently incises the tissue without the need for a scalpel. Therefore, there is less bleeding, less discomfort, and less risk for infection.

There are a few different options available for patients who wish to straighten their teeth. If your misaligned teeth are interfering with your smile symmetry, a well-balanced bite can make all the difference. If your orthodontic issues are mild to moderate, you may be eligible for Invisalign®. This system straightens your teeth discreetly with a series of clear removable plastic trays. Many of our patients choose this option because they enjoy the fact that the aligners are virtually invisible.

If your misalignment issues are more complex, traditional orthodontics may be a better solution. Braces will not only straighten your teeth, they will correct your bite, giving you optimal function. When your teeth are in alignment, you significantly lower your risk for gum disease and tooth decay. While orthodontics may be a substantial investment of your time, braces can provide you with healthy teeth and gums for many years to come and correct your asymmetrical smile.

Occasionally, teeth will be different sizes when they grow in. Sometimes, they can be misshapen. In these cases, your Lone Tree cosmetic dentist can place porcelain veneers. These custom-made restorations can conceal an array of aesthetic imperfections. They can make teeth seem larger, give them a more natural shape, and even make them appear flush to the adjacent teeth. Porcelain veneers are quite versatile and can be used to address a number of cosmetic concerns.

In some cases, the best results may come from a combination of treatments. This is often called a smile makeover. If you have misaligned teeth or a crooked smile, perhaps a smile lift and veneers will deliver just the result you are looking for. No matter what your goals, we can help you design a custom treatment plan to meet your needs.

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