What are the approximate number of units of Botox required for jaw reduction?

Question

I've done approx. 100units of Dysport on each side sometimes in February and my current doctor is saying she usually does 50 units of Botox on each side (total 100 units) but i've read online and people usually get 25 units each side (total 100 units). Pls help!!!!! Also my chin fillers which I did are kinda lopsided, like its sort of longer on one side than the other. Is there any way I can remedy this?

Brock Ridenour, MD · Answer

To slim the face, Botox is injected into the masseter muscles. Appropriate patients for treatment have significant volume of muscle, rather than a strong bony prominence at the angle of the jaw (mandible). Injecting the masseter muscle with Botox decreases the prominence of the muscle and tapers the lower face. Dosage depends on the patient's muscle volume, together with regional and cultural variations in the amount of taper than is considered desirable and attractive.  In patients with small faces and modest muscle volume, tapering can be achieved with as little as 9-12 units per side. In patients with a large muscle volume the dosage required can be as high as 20-40 units per side. Most patients get noticeable tapering of the jaw with modest dosage. It is only patients with large muscles that require the higher dosage. The "equivalent" Dysport dosage would be anywhere from 30 to 100 units per side. Your lopsided chin can be managed by either dissolving the excess filler on the longer side or adding additional filler to the shorter side. I hope this helps. Best wishes to you.

Jason Emer, MD · Answer

Botox can be injected into these areas to create a softer look and to help with TMJ. The botox will essentially relax the muscles creating the appearance of atrophic muscles. The results will last up to 3-4 months hence you will have to re-inject roughly 3x per year. When administered by an expert injector you shouldn't have an issue with too much laxity and should know the amount of units that should be used to get the results your desire.
If you're unhappy with your final results for the filler in your chin, you can have it reversed with hyaluronidase and try a different technique next time. I recommend seeing a facial sculpting expert.
 Best, Dr. Emer

Steven H. Williams, MD · Answer

Hi,Thank you for your question. The unit dosing for Botox and Dysport are different so it's not valid to make side by side comparisons. Generally, 20-25U of botox or 50-60U of dysport per side is a safe starting point (on the low side) for masseter injections. Depending on the extent of hypertrophy, up to 40U of botox and an equivalent amount of dysport can be used. Typically patients will require more than one treatment spaced 3-6 months apart. The masseter muscle does take some time to atrophy and show the effects of facial slimming.As for chin filler, there are 2 approaches that can be taken. If you prefer the more projected side, more filler can be injected to achieve better symmetry. If you or your injector feels there is too much volume, a dissolver can be used to reduce the volume/projection (if a hyaluronic acid (HA) filler was used).Hope this was helpful!

Nadja Haub, MD · Answer

Hi there,
Thank you for your enquiry. From what I understand, you had a Dysport treatment to slim the muscles on both sides of your lower face, close to the jaw. 
This muscle is called the masseter muscle. From my experience, this muscle can vary quite a bit in size. It tends to be bigger in male patients, people who go the gym a lot or clench their teeth at night. It is also often bigger in people of Asian origin.
Botox or Dysport relaxes the muscle. The bigger the muscle, the more Dysport or Botox is often needed to relax this muscle.
What you also need to know is that 2.5 units of Dysport equal only 1 unit of Botox. So in your case, when you say you had 100 units of Dysport, that equals 40 units of Botox. 
Most people require 3 injections of 5 units Botox (equals 12.5 units Dysport) on each side. This can greatly vary from person to person depending on how big the muscle is.
With regards to the dermal filler in your chin, it sounds as if you had two injections on each side of the chin. Maybe the doctor or nurse injected a slightly bigger amount on one side compared to the other. This can cause asymmetry. If this was the case, it can be easily corrected. Another option could be to dissolve the dermal filler with an enzyme called hyaluronidase.

Benjamin Barankin, MD, FRCPC · Answer

There is no set answer for this, depends on how strong your muscles are, etc. For most people I do between 21-36 units of Botox per cheek/masseter muscle over 3 injection points. You can always start at a lower dose, and add more later, whereas you can't take it out if too much was put in. Best to speak to a highly trained and experienced physician injector such as a dermatologist for optimal results and safety, especially when doing Botox jaw reduction.

Michele S. Green, MD · Answer

The amount of Botox depends on how large of a masseter muscle you have.  The range is anywhere from 20 units to 50 units on each side.  The filler in your chin can be easily dissolved with Vitrase and I would consult an expert in fillers and Botox.  Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question seahisabelle. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Depending on the reason for the enlargement of the muscle, permanent results may be achieved. For example, some people have a habit of grinding, clenching, or biting their teeth subconsciously. Often times this happens in their sleep when they are not aware of it. Botox placed in this muscle will relax the muscle and the grinding, clenching, and/or biting will decrease. This will reduce the size of the muscle. If the brain gets accustomed to this and the person stops grinding, clenching, or biting, then the muscle will not become enlarged or as enlarged again. However, if the habit starts again, the muscle will likely get larger.
  To determine if someone is a good candidate for this treatment it is necessary to look at a person’s lower face when biting and comparing it to when the person is not biting. If a bulge is seen on the outer portion of the jawline, then the person is likely a candidate. It can also be felt with the fingers when biting.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Shaun Patel, MD · Answer

We have considerable experience with Botox/Dysport treatment of masseter muscle enlargement and based on that experience an average starting dose for our patients is 20-30 units of Botox per side or an equivalent amount of Dysport. We do see our patients at a two week followup if need be to add more Botox or Dysport as needed. Of course it is hard to estimate the right dose for you without evaluating you in person.

Anteneh Roba, MD · Answer

Inmost cases of master injections with Botox to shape the jaw we suggest about 50 units per side, plus or minus a few units depending on each case.

Leonard Grossman, MD · Answer

In order to be able to answer your question better, you should have submitted some photographs or have an in-person consultation. in the majority of patients 25 to 30 units of Botox are sufficient, this would translate into 75 to 90 units of dysport per side. As far as the fillers in your chin is concerned, you can can have more fillers addedbor have the filler reduced in volume by the use of hyaluronidase. Good luck from New York City

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