Hello GataC and thanks for your question. Injecting Masseters with Botulinium Toxin (BoTA) is a big part of my practce. When I am treating a patient for Bruxism for the first time unlike my approach with 'cosmetic' injections, I prefer to use higher dosages. I want to know whether or not the treatment si going to work for that particular patient and not have them 'guessing' the efficacy of the treatment. With 'cosmetics' , I prefr the "less is more" approach. Depending on the dilution factor used when reconstituting the Botulinium Toxin the number of injection points may vary. A larger dilution will result in greater spread of the solution, yet one must remember that the dose is also affected. Generally I use 2 injection points as a minimum with a 2.5ml dilution to 100 units of BoTA. I then inject 40 units on each side, that is 20 units at each point. In patients who are symptomatic and have jaw / muscle aches / pain, i will also inject 10 units in 2-3 points in the Temporalis muscles on each side.
Hello Shihio and thanks for your question. The placement of fillers is a tricky and sometimes unpredictable procedure. Treatment outcomes cannot be guaranteed, and when undesirable effects are seen may require further treatments to correct. In your case, it is a little difficult from the pictures supplied to determine exactly what went wrong and to what extent. It is still 'early days' and you may still have some localised oedema (swelling) at the site of injection that will resolve and things may not end up looking as it is now. I would in the short term obtain some 'Arnica Cream' and apply it to the area and massage the lump from inside and outside of the mouth between your fingers in an attempts to flatten out the 'worm'. I would repeat this 3-4 times per day and review the situation in a week or so. The filler material (I'm assuming a HA Filer) will also uptake some surrounding moisture and soften a little over the next few weeks which may also reduce the unsightly appearance that concerns you. If all else fails, then I would return to the practitioner who first treated you (or some else you trust - do some research) and request that he / she dissolve the filler material with Hyalase (Hyaluronidase) solution. Best of luck, I hope this has been of some help.
Hi Tam, I can see what you mean by having an uneven smile, thats so unfortunate especially when injecting Masseters is a relatively simple procedure. The use of Botulinium Toxin (BoTA) to reduce the muscle activity in patient with Bruxism (tooth clenching and grinding) is normally a straight forward routine procedure that I as a dentist perform on a daily basis, however it is important to assess each individual patient's presentation and needs in order to determine the exact dosage required and the best position to inject within the muscle. What is also crucial is the 'post operative instructions' that are given to a patients for the 4 - 5 hours following the administration of the BoTA in order to prevent the undesirable complication that you seem to have experienced. I think you smile will start to return to normal very soon if the BoTA was delivered 7 weeks ago. I would suggest the BoTA in your case has drifted forwards on the Right hand side into the 'risorius' muscle which attaches close by the corner of mouth..... hence the right corner of your mouth doesn't respond when smiling. I hope this has been of some help.
Hi there and thanks for the question. Botulinium Toxin (BoTA) injected into the Masseter (cheek / biting) muscles is one way of reducing the size of the cheek and taper the face and works very well in patients who have enlarged muscles due to Bruxism - clenching and grinding of the teeth. When having these treatments, I find it very important for patients to be consistent with treatment repeats and not allow the muscles to enlarge to their original size as the BoTA begins to wear off. Some people we find also have large buccal fat pads in their cheeks and the size of these will not be affected by the BoTA injections. 'Bucal fat pad' removal from the cheeks can be performed in these patients, but appropriate case selection is very important as once the fat is removed it is gone. One must remember that it is a more invasive procedure than BoTA injections with some downtime due to bruising and swelling.
Hi there 'surfinbabe',I'm really sorry to hear that you are suffering as you are. As a dental surgeon who performs Masseter Botulinium Toxin injections daily, what you have described sounds very unusual. I inject Masseter muscles for both aesthetic and functional reasons, to slim faces as well as treated bruxism (tooth clenching and grinding) in symptomatic and non symptomatic patients. I cant remember having a patient describing a complication like your before. If you haven't had and improvement or resolution of your symptoms / signs, i would seek out a local dentist familiar with the procedure for a review to rule out infection. If you have a deep muscle bruise (heamatoma) I suspect this will resolve shortly. Al the best of luck.
