Botox Masseter Reduction for Masseter Hypertrophy and Bruxism (Teeth Grinding)

31 year old Asian woman with Masseter Hypertrophy and Bruxism (Teeth Grinding) treated with Botox to her masseter muscles. Her after photo is ~3 years after she began her treatment when she was 28. She has since had multiple touch up sessions using about 20 units of botox on each side to maintain the result without overshrinking her jawline. She receives botox between 4-6 months but most patients return around 6+ months to maintain the results. If the masseter muscle bulk is low, then less botox is used. If the masseter seems thicker or assymetrically thicker, then the Botox dosing is adjusted accordingly. Note that even though she is returning for a touch up treatment, her cosmetic result is still maintained. Her main reason for returning to receive more Botox injections is when she feels tension in her jaw or notices that she is grinding her teeth more. Before she fully bulks up her masseter again she can be retreated with a smaller dose of botox to maintain the muscle relaxation as well as the cosmetic result. She can wait longer and allow her muscle to bulk up more, and this longer interval would mainly result in more Botox being used at the touch up session. Additional tips given to the patient to help lengthen the duration between Botox treatments, are strict avoidance of hard, chewy or crunch foods, no gum chewing, chewing on both sides of her teeth as equally as possible. The less "work out" the masseter muscles receive, the less they will hypertrophy. For patients who are over 40 years old, Botox to the Masseter muscle needs to be used carefully. If an older patient who has some early signs of facial aging receives too much botox to the masseter, this overshrinkage of the muscle can cause jowling or sagging of the jawline. This does not appear to affect younger patients.