How do you tell if swollen cheeks are a parotid gland issue or a jaw muscle issue? (Photo)

Thank you for the question. Fullness along the jawline can be salivary tissue (parotid glands) or enlarged chewing muscles (masseter). The difference can be felt by palpating the angle of the jaw with the patient relaxed or biting down on the back molars. This gives an indication of the strength and volume of the muscle. For men, doses can range from 10 to 20 units per side when treating the muscle. Best of luck moving forward.

It would be best if you went in for a consultation with a qualified plastic surgeon. He could palpate and conduct other checks to see if it is glandular or muscles.The number of units could vary depending on what the issue is and how large the muscle groups are. I'd recommend going and getting a qualified consultation with a doctor you trust so you can get the right treatment. It would be unfortunate if you tried Botox and it was actually glandular. Sincerely,Dr. Jerome Edelstein

Thanks for the question and thanks for including the photos as well. You need to have a consultation with a board-certified dermatologist or plastic surgeon so that the area can be thoroughly examined and as this looks like masseters, the proper treatment plan outlined. In men, upward of 20 units of Botox per side is not uncommon – and the injection technique will differ based on the person doing this. Most would use 3 sites per masseter. And on occasion, more than one session is needed to make the proper correction.Find the right injector, get examined, and then get the proper treatment.

It's academic to say whether it's parotid or masseters.  Typical dosing is up to 40 units per side with Botox.  Please see my blog post below as well.

The masseter muscle attaches to the mandible about half an inch in front of the back corner of the jaw bone.You can feel it bulging when you clench your teeth down back-and-forth.The lowest part of the parotid gland sits a little further back almost at the back lower corner of the mandible right by the bottom of your ear lobe. It can sit as high as your cheekbone.Any parotid gland growth or tumor can be anywhere within the parotid gland.One way to differentiate would be to feel the muscle while it's contracting.If it feels like there is a mass or a lump when the masseter muscle is completely relaxed, then there may be a parotid gland growth.Also, if one side looks significantly different than the other, this could mean the possibility of a parotid growth.The fact that you haven't even mentioned a possible parotid mass, tumor or growth leads myself and most likely the rest of the physicians on this forum to recommend a workup for a parotid mass.These are typically done by an ENT (ear, nose and throat) specialist, also known as head and neck surgeons.Some surgeons with ENT background also refer to themselves as facial plastic surgeons.If you have had Botox injections to your masseter in the past and liked the results, then continuing these treatments may be a good idea.Men typically need more Botox then women.For women, typical injections are 30-40 units per side. In men, 40 to 60 units may be more appropriate.You may also find better long-term results having more frequent injections.I often tell my patients I would rather see them have lower doses on a more frequent basis.This allows for more muscle atrophy, which is what we are trying to achieve, particularly with masseter treatment using Botox.Please follow up with your primary care doctor or, preferably, an ear, nose and throat specialist to make sure you don't have a product growth.Best of luck,Mats Hagstrom, M.D.