botox

I have lower lip weakness to my bottom lip due to mandibular nerve injury. I have a mild permanent crooked smile. I am trying to find the best procedure to help correct this cosmetic issue. The only thing I can find is treatment using botox or another more permanent procedure myectomy. My question is if you treat with botox how does the doctor know how much botox you will need? Second if you go with the more permanent procedure myectomy how does the doctor know how much muscle to take out? Lastly which procedure is the best one out of the two to have the best outcome?

[Michael B Wolfeld, MD]

Thank you for your question.

It is difficult to give you a direct approach to help your nerve deficit without a physical exam.  Botox may provide a better approach to start with since it is only temporary and you can assess if the results are pleasing to you.  A physician may start with a lower dosage of botox and depending on your results, may give you more to get the optimal result.  You should wait at least 7 days following the botox administration to assess the results.  Once again, you should start with a consult with a plastic surgeon or ENT to examine your deficit and to discuss a treatment plan.

[jojoromano]

Thank you Dr. Wolfeld I was thinking less was best to start off with too. Then like you said follow up in a week and see if I would need a little more. The hardest part will be finding the right doctor who has experience in adjusting this deficit with botox. This is really stressful considering this lip thingy happened as a result of a cosmetic procedure. Now looks as though I'm gonna need a PS to fix me for life. Which reminds me of a movie called Death Becomes Her with Meryl Streep, Bruce Willis, and Goldie Hawn in it. I remember a part of that movie when Meryl Streep and Goldie Hawn start screaming at Bruce Willis "fix me, fix me!!!!" lol