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Botox for Reducing Masseter Muscle Made Me Look Jowly - Vancouver, BC

Not Worth It
Spent: $800 in Vancouver, BC

Comments (25)

Posted 28 Aug 2011

I'm forty-one and had my square jawline slimmed with two botox injections appts spaced a month apart. As with all the botox I've had, it was very effective. The trouble is, the loss of volume there made me look jowly. I have, in effect paid good money to look older! Beware of this treatment if you are over forty or have some skin laxity in your face already!

This review is the subjective opinion of a RealSelf member and not of RealSelf, Inc.

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Comments (25)

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KitteNYC 5 Sep 2011
Omg, I have the same problem. I'm only 19. The Botox caused a pseudoherniation of the Buccal fat pad, allowing it to "slide out" into the peri-oral mound area. It only affects me on one side, but the effect is extreme. It's been nearly 4 months...of hell...and I'm hoping what I'm seeing is improvement. I'm so depressed because this is the biggest fück up I've ever made. I'm praying this goes away.
True2type 6 Sep 2011
Gosh, I'm really sorry to hear that! What did your doc say about it? Could one of the Trueself docs chime in with some info? I'm assuming that, when the botox wears off, I'll regain the volume lost in the masseter area and all will be normal again--am I wrong?
KitteNYC 6 Sep 2011
My doc (like most uneducated and egotistical docs) said it must have been there before and Botox can't do that and I'm imagining it. I've had two ENTs, a maxillofacial surgeon and a cosmetic surgeon all agree on it's existence, and MRIs and CAT scans of my head, as compare to last year, show that the fat in my left cheek has descended from it's original position. I'm not really sure how a doctor could continue to refute my "opinion." I'm praying this goes away. I have body dysmorphic disorder and my face is extremely important to me because I feel it is so ugly. Beauty is symmetry, so this asymmetry, logically, has made me uglier. I paid a great deal of money to make myself uglier. No one notices that, everyone thinks I'm beautiful, it doesn't matter. I FEEL it in my face. It is the entire focus of my existence. I can think of nothing else. I cannot smile. The urge to end my life is so strong i just don't know what to do with myself. I've given myself two years. If I am 21 and my face is still fucked up, I will kill myself. I can't believe this is happening to me. This is torturous. I can't believe this happened to me.
BrittB 7 Sep 2011

Hi True, 

I'm so sorry, I have not heard of that happen. I wonder if you body had an allergic reaction or something. Thank you for sharing you story, so others who have the same effects will know they aren't alone. Please keep us updated.

Thank you and enjoy the rest of the week!

-Britt 

KitteNYC 8 Sep 2011
Brit--it's actually not an allergic reaction. Truetotype and I are suffering these symptoms because our doctors either incorrectly determined the injection site (my doctor injected my buccinator muscle by accident, though this is as much my fault as his. I didn't realise my masseters were still so weak from my first treatment in september '10 because of my body dysmorphia. I didnt realise my face was already too thin. Inexperienced doctors are told to ask the patient to bite down and then inject whichever bulging points in the jaw are visible. Obviously this is extremely inaccurate and had my doctor had a solid understanding of facial anatomy/the decency to refuse to treat me [aka take my money] because of my somewhat obvious obsession with my face/the fact that my masseters were still so weak, this would not have happened. My masseters were so weak that they could not move, therefore couldn't flex and bulge. Only my buccinator muscle could. So, he injected that instead) or the botox may have been correctly placed in truetotype's case, but it spread into and affected her buccinator muscles. The buccinator and masseter hold in the Buccal fat pad. Normally, as we age, our muscles waste and the Buccal fat pad descends from it's youthful position into what we call "peri-oral mounds" and later, jowls. Since I'm only 19 my fat pad luckily only descended into the peri-oral mound area (this is the area on either side of the corners of our lips--peri-oral mounds are very noticeable when talking or smiling, but almost undetectable when relaxed. Since I'm only affected on one side, my smile is crooked and half my face lacks the definition it used to have). This complication is referred to as a "pseudoherniation of the Buccal fat pad." You may have heard of victims of "pseudoherniation of the peri-orbital fat pad." This frequently occurs when botox is incorrectly placed or spreads around the eye, thus paralysing the delicate muscles that hold that fat pad in. I've scanned these message boards for those patients' stories, and most of their complications seem to have resolved after 9-12 months, so this gives me great hope. The only problem is that the muscles found in the jaw are composed differently than those found in the eye, and seem to be much more reactive to Botox treatment. This is why they atrophy within weeks and why the eye muscles never reduce in size (at least to a noticeable degree). So, we two patients will are truly experiencing an entirely unknown and unfortunate undocumented complication of Botox treatment.

I've included so much information here because I've done 4 months of intense research and I want truetotype to understand exactly what is happening because I dont want her to seek any sort of surgical treatment for her new jowls. This may resolve on it's own and if so, she will look over-corrected. I do NOT want to I instill the same obsession I have with this complication in her. My obsession is unhealthy to the point of debilitating. I feel really embarrassed and sorry that I included so many of my raw emotions in my last post. It's just that I have so many happy things in my life and yet all I can ever think about is this. If this does resolve, I will be so grateful for the natural beauty I possess and will never again take that for granted. I can only hope that my obsessive research can help you and others. I just want to help.
True2type 9 Sep 2011
Gosh NYCkitten, I'm so grateful you've taken the time to go into such detail. It's given me some peace of mind about this and armed me with info I will take to my doctor (who's initial response, incidentally, was that this was all in my head--just infuriating). THANK YOU.
KitteNYC 9 Sep 2011
I'm so glad you found my info useful...obviously this is really affecting me but at least I'm not "the only girl in the world" with this extremely strange complication. Botox is so dangerous not because of it's chemical makeup but because of how it's experimentally used. We have no idea why the masseters shrink so profoundly and what the long-term effects of this are. No idea. We just know it doesn't kill people. I can't even deal with a doctor who says it's all in my head. That's the epitome of cowardliness and ignorance. Why are they not fascinated by what could be NEW knowledge in cosmetic enhancements? Why wouldn't they want to "discover" this? All of the NYC doctors I've gone to learn to treat me with a certain amount of fear because I can actually understand and reply with all the big words they use to confuse parents into saying, "well gosh, you're the doctor!" I'm not falling for that. This is why I want to be a doctor. To save people from doctors. If you don't mind, true2type, I'd like to stay in contact with you so we can update eachother on our conditions...is that alright?
KitteNYC 9 Sep 2011
*patients, not parents.

By the way I never asked you...are the jowls on both sides? My complication is unilateral. Also, how many units did you get in each side at each time?
True2type 10 Sep 2011
You obviously have a fantastic brain NYC. You will make a first-rate doctor. As for the jowls: the droop is on both sides and my cheeks look sunken. I've booked three Accent skin tightening sessions in the hope that I will be able to to improve my jawline somewhat while I wait for the botox--and the hang-dog look it's caused--to wear off. I'm terrified that some of this will be permanent. I can't remember how many units were used but I will call him Monday and let you know. I actually had the injections three weeks apart, which is a week sooner than is recommended, because he was going on holiday. The first injection made a subtle, pleasing change. If only I'd stuck with that! Would also love to keep in touch.
KitteNYC 12 Sep 2011
I really wouldn't go with the skin tightening treatments...this is a muscular problem, not a skin laxity problem. Can you please post or message me some pictures of you? I need to fix this and you're the only other person on earth that I know is currently suffering from it. I wish you were 3 months ahead of me, though...but nevermatter. Some pictures (preferably six: three not smiling [front, 3/4 left and 3/4 right] and three smiling [same positions]) does this affect your smile by the way? This is undetectable on me until I smile.
True2type 12 Sep 2011
Ah well, I did have the first Accent treatment last week and it has helped! I think this is because, in my case, the problem is more removing volume in a face that's already experiencing some fat descent and skin laxity. While your guy definitely hit the wrong muscle, my guy just failed to warn me that removing volume could backfire at my age. My cheeks are fairly symmetrical, smile or no.
oncebeautiful 14 Sep 2011
Hi true2type! I have also experienced joweling from botox to correct my overdeveloped masseter muscles and found that it emphasized buccal fat pads.

I was wondering the results of your accent treatment to correct joweling and if you would recommend it. Thank you!
True2type 15 Sep 2011
Hi oncebeautiful, I have had one Accent treatment so far (you have to space them out about a month) and I'm very happy with it. I go to a derm office for it, although it's performed by a aesthetician, and the procedure takes almost an hour. I mention this I've read some accounts of ten-minute sessions at spas that haven't worked. I see definite improvement after one treatment and am excited to see the results after I have two more.
KitteNYC 1 Oct 2011
Hi everyone. How are you all? Any improvement yet? I took photos four months ago but it's so hard to tell if what I see is improvement or wishful thinking. Through my research I've determined that even if this complication does not resolve by itself, it can be reversed through the same methods used in a "Mid-face Lift." The jowls are made of fat that was once stored in the apples of your cheeks, but have descended due to those cheek muscles getting weaker. A mid-face lift addresses this by tying a few threads through the descended fat pad and pulling it back up into position. Very similar to a "permanent" bra (lol). The only problem is that since the fat pad has vertically descended, an incision would need to be made under the eye and under the jaw in order to pull it back up vertically. The midface lift makes incisions in the temple hairline and under the jaw, but this pulls the fat pad diagonally over the cheekbone, where it never was. We're looking to restore our fat pads to their position of origin, not to an alternate location. I know every doctor is telling us botox is never permanent buy more, but honestly, if jowls are caused by muscle loss, why wouldn't older women be able to completely restore their faces through facial exercises? Maybe they are, and the medical community just doesn't entertain this idea? But if they're not able to, despite training their muscles to be stronger, then I'd have to think that once the muscle "lets go" of the fat pad, it's not able to naturally "re-grip" it. In our cases our muscles were forced to let go, and I'm only hoping that they can wake up one day and grab that fat again...
True2type 1 Oct 2011
This is interesting because I've noticed a horizontal indentation on the apple of my cheek in the last few years, something that roughly coincides with using botox for crows feet (a few shots at the side and underneath the outer eye). Getting the masseters done caused a real hollowcheeked look in addition to the jowls. I'm thinking more and more that women should avoid using botox below eye level, period.
True2type 1 Oct 2011
I've been looking at Sculptra as a possible solution lately. Originally used to treat facial wasting ing AIDS patients, it causes the face to build more collagen and can be injected anywhere. Thoughts?
KitteNYC 1 Oct 2011
Has everyone here also had eye Botox? I had my masseters treated one before with beautiful results and 8 months later had it repeated with a pretty high amount of Botox put into my brows (10 for each, and I really never ever raise or furrow my brows. I wasn't able to form a crease in-between my brows before the botox lol) it was this treatment that caused the pseudoherniation.

I would really urge you to hold off from any semi permanent fillers. Say this suddenly resolves by itself after a few sculptra treatments...you'd have Cher cheeks for 2 years. Lol. I really encourage you to try a more conventional filler like Radiesse. It's used commonly for cheek augmentation but it's results are more temporary so if you don't like it, you just wait 6 months.

Wait were you thinking of using filler for the apples of your cheeks to try to pull up the jowls or filler to replace the facial mass lost due to masseter atrophy?
True2type 1 Oct 2011
I was thinking the Sculptra might be a good thing for the hollowness under my cheek bones. As I understand it, it's not really a filler. Rather, it fires up collagen production in a big way so that your face fills out gradually over about three months, and in a very natural-looking way. It's expensive of course.

I've had Botox around my eyes for years now and have always thought it thoroughly wonderful. Started doing the crows feet two or three years ago and I wonder if relaxing the muscles under my eye also relaxed my cheek muscles and sped up the descent of fat in that area.
KitteNYC 1 Oct 2011
I wish you'd message me pictures of your complication...I know a lit about thus, but its so hard to try to give appropriate advice when I can't see the problem...I'm harmless I promise. Just a really neurotic teen girl.
True2type 2 Oct 2011
I'll think about it NYCkitten, but I do hate pictures! :)
KitteNYC 2 Oct 2011
I completely understand. I have my picture taken like 3 nights a week and I haven't smiled in a single one since may! Ugh. I never smiled anyway but I swore to myself I'd smile in every picture if this goes away. Are you seeing any changes, better or worse?
True2type 2 Oct 2011
A little better, I think. I have another Accent treatment scheduled for Tuesday. It will be a couple of months until I can judge the full effect of three treatments. As to your predicament NYCkitten: I am quite sure your face will return to normal. Skin is so healthy and elastic at your age, it can handle just about anything. When that happens you're right to resolve to appreciate it this time round. There's very little under sun more appealing than a pretty young face. Don't mess with it too much. It's a gift that doesn't come around twice.
KitteNYC 20 Oct 2011
Hey true2type,

how are you doing? I've been looking at the pictures I'd posted back in may, and gosh, the improvement is pretty obvious. It sure is SLOW though...so slow that it literally does not look different even over a month but you add up 5 months and it's noticeable. I'd LOVE this to be completely gone by christmas. That would be the best present ever...
KitteNYC 20 Oct 2011
ALTHOUGH i have to add: i started chewing gum on the side that was affected (this masseter was always bigger) and now my masseters are asymmetrical again. FML. You really can't win. The problem, despite my masseters gaining what seems to be full functionality (I can flex them again) this complication is not entirely reversed, which affirms my theory that my dr. hit a muscle other than the masseter. some muscle in the cheek that is responsible for lifting the apple of the cheek...there are SO MANY facial muscles though! it's unnerving to try to theorise which one might be suffering right now

also scary: a three-year study of patients who underwent botox treatment to the masseter showed continued "bone remodeling" way after the botox was supposed to "go away." Meaning, our jawbones are weakening and becoming less dense (cosmetically disintegrating). Fun with neurotoxins...
Gbeana 11 Feb 2012
KitteNYC and True2Type, It is Feb. 11, 2012... where do each of you stand at this point? Your last posts are dated 10/20/11. Has this problem been resolved; has your face returned to normal? I had a little botox in my chin about 3 weeks ago and now my smile is messed up. I, like so many people who have used botox (now that I have read these posts) just want my face and my smile back. Help!

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