Can I Slim a Square Face with Botox? (photo)

Hi Mittenz.  You are an excellent candidate for masseter reduction using Botox (Dysport).  We have had good outcomes with this procedure in as little as 1 treatment, but let patients know they will need to do it 2-3 times per year to keep up.  We use either 25 units of Botox or 75 units of Dysport on each side during the procedure.  You can click through on the link below to see results.

Thank you for your question and for sharing your photos.  You would be an excellent candidate for Botox in the masseter muscles.Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep. Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox wears off completely.

Botox injections to reduce a square jawline usually has excellent predictable results, as long as this shape is indeed caused by the masseter muscle, not the underlying bone of the mandible (a simple physical exam will determine this).  Typically 10-20 units per side is necessary, depending on the mass and strength of the muscle being treated, although sometimes I have needed 30 units each side.  If too much is used, you may lose strength in your bite, but this is temporary.  Try to avoid surgical reduction of the underlying bone, as it is costly, has significant recovery, and is difficult to achieve symmetry.

You have masseter hypertrophy, which is causing a bulkiness to your lower face, and you are an excellent candidate for neurotoxin to reduce masseter hypertrophy.  You will notice the slimming effect on the lower face within several weeks.  If you like the effect, you will want to repeat your injections periodically.

A way to estimate whether or not you should expect any improvement with masseter reduction using Botox is to stand in front of a mirror.  Look at the angles of your jaw and compare the clenched versus unclenched contour.  Then put each of your hands on each side of your jaw.  Again, feel your jaw when it's clenched versus unclenched.  The muscle at the angles of your jaw you are seeing and feeling is the masseter muscle.  The Botox will reduce the bulk in that area from the muscle, but if your jawbone is still extremely wide despite pressing down on the muscle then you will experience only minimal improvement.  

Based on the photo's you've provided, you look like a great candidate for masseter reduction with Botox. Visiting with a well-trained and reputable provider will help you determine how many units would be needed to achieve an aesthetically pleasing look - and also educate you on a long-term plan.

Botox in the Masseter (jaw muscle) is actually the
#1 safest area to inject Botox. It is even safer than the glabella, which is
the area in between the eyebrows. Because you have a bit of a stronger
jaw on your left side, I would inject more Botox in that side, but both of them
can benefit. I usually use 20-25 units of Botox per side. Remember,
Botox in the masseter takes longer to work than other areas, don't expect for
it to start kicking in for at least 2 weeks. Its effects can last about 4-6
months. A repeat treatment can help continue to diminish the size.

A wide 'square" jaw is often due to an enlarged masseter muscle. You can feel this muscle by clenching your teeth and feel it harden. Botox or Dysport work very well to reduce the size of the muscle. It is rare to have patients complain of chewing problems, because the temporalis muscle (the major chewing muscle) is unaffected. It is more likely that incorrectly placed injections will weaken the smile muscle. It may take 6 weeks to see the results after injection. For practitioners, I describe the technique in my book: Cosmetic Injection Techniques, available on Amazon.com in May 2013.

Please consult a dermatologist or plastic surgeon who can assess your masseter muscles, especially on the left side, to determine if you are a candidate for Botox or Dysport injections.

While I cannot speak to the integrity of the clinics you mentioned, they are giving you good information about using botox to soften a square jaw. Its a safe and reliable way to shrink the muscle at the angle of your jaw, which gives it that square appearance.

Using larger doses of botox over a short period reduces the muscle bulk more quickly, while smaller doses over a long period of time reduces the muscle more gradually. I like to inject 20-40 botox units monthly, followed by biannual maintenance injections thereafter. I try to achieve  25% reduction in muscle mass prior to beginning maintenance. This give a pleasing contour to the jawline in most people.