Bulging masseter after Dysport injections. Will this go away? Can I go to a different injector soon to correct this? (Photo)

Hi. It looks like you're experiencing PMG (paroxysmal masseteric bulging). This can occur when the entire masseter has not been relaxed by the botulinum neurotoxin type A. The masseter muscle contains both deep and superficial muscle fibers which are divided by a structure called the deep inferior tendon (DIT). PMG can occur when only the deep muscle fibers are injected below the DIT and are unable to diffuse into the more superficial fibers. Prominent bulging when chewing can occur from overcompensation of the non-treated superficial muscle fibers. PMG can also result from superficial injections which do not penetrate through the DIT, leaving the deeper fibers unparalyzed. This can be corrected by treating the fibers that were not relaxed or will self-resolve as the Dysport wears off. Facial slimming can occur with Dysport, with the dosage typically depending on the strength of your muscles. In regard to 20 Dysport units, Dysport units are 3x Botox units, (20 units Botox 60 units Dysport). Thus 20 units would be standard for a Botox masseter treatment or its equivalent in Dysport. Hope this helped!

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Hello Sincere703497! My name is Jessica, I am a physician assistant and one of the providers at Shah Facial Plastics. In general, Botox for masseter slimming often requires 20-30 units to reduce the size of the masseter muscle. Based on your history, it seems as though the superficial muscle fibers have been paralyzed and thus the deeper fibers can protrude more. This can occur with the masseter muscle if the Botox was not injected deep enough. If the muscle is still protruding after 2 weeks, it is recommended to receive a touch up.

I'm sorry to hear of the issues you are having from your Dysport treatment. It can take two weeks for you to see your final result from treatment. If after that time you still have concerns you can return for a touch up for correction. You may need a little more Dysport, but the amount you received is within the range of a normal starting dose.