Long story short, don’t be like me: It’s absolutely imperative to convey any issues to your injector before, during, and after treatment.
Why an asymmetrical smile can occur from masseter injections
While one study conducted at the University of Pennsylvania School of Medicine and published in a journal, Dermatologic Surgery, showed that injecting botulinum toxins into the masseter can actually correct an asymmetrical smile, according to the dermatologists I spoke to, the exact opposite can occur if the placement is just a few millimeters off—specifically if the neuromodulator hits the risorius muscle, which is responsible for pulling up the corners of the mouth, explains Dr. Lee.
Aside from the exact location of the injection, the depth of placement also matters. “Smile asymmetry is more likely to occur if the injection was placed too superficially to the masseter or directed too close to the mouth or cheeks,” says Dr. Lee. “A few millimeters can absolutely make a difference.” This can occur if the needle itself is too short, and therefore unable to reach the proper muscle.
When it comes to the injection technique, Dr. Lee says it’s extremely important for your injector to feel your facial muscles when clenched and when relaxed to assess imbalances in the muscle or underlying bone. “From there, your practitioner should inject deeply into the muscle while angling the needle away from the risorius,” she says. “This helps minimize the risk of unintended diffusion and reduces the chance of affecting smile symmetry.”
Dr. Nussbaum also emphasizes that less is more. “You can always add more units later, but you can’t take any away.” The brand of neuromodulator has less of an impact and shouldn’t necessarily result in an adverse side effect unless you have an allergy. Above anything else, it’s crucial to only get injected by trusted board-certified dermatologists or plastic surgeons. My case is especially interesting because I did go to a dermatologist.
If you do end up with an asymmetrical or crooked smile as a result of masseter injections, find some peace of mind in the fact that it will fade eventually—in about three to five months, depending on the neuromodulator used. “The good news is that smile asymmetry from masseter neuromodulator is temporary, and actively using the affected muscles can help speed up recovery,” says Dr. Lee. Giving yourself regular facial massages and even chewing gum can accelerate the process.
Despite the harsh realities of my experience, I’d get my masseters treated again—and recently got a flawless re-up from a different dermatologist, Dr. Nussbaum. No deformed smile this time around! The treatment eased the jaw pain caused by excessive clenching and slimmed my profile. So, if you catch me beaming from ear to ear, just know I’m making up for five months of lost time.
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