Botox for Square Jaw Reduction and Face Seems Distorted Now

Hi i had 40 units botox for square jaw reduction 3 weeks ago. This is the second time im doing it after 2 years. However, this time results are not seeming too similar. After a week, the masseter area started to swell or it seemed like there was an increase in mass. Called up my doc he said its normal. Now it has been 3 weeks and the area between the cheekbone and earlobe or rather under the cheekbone appears to be tight and slightly swelled up. Is this normal? And what could possibly be wrong?

Doctor Answers 6

Botox for square jaw

Repeated treatments with botox to masseter and temporalis muscles can reduce the square jaw appearance due to masseter hypertrophy. This requires several injections over a period of 1-2 years. Botox decreases the muscle bulk (masseter muscle) and thereby, makes your lower face look more slim. It is also an excellent treatment option for those patients who grind or clinch their teeth.  

Virginia Beach Facial Plastic Surgeon
4.7 out of 5 stars 37 reviews

Swelling after Botox masseter treatment

Please see the doctor who treated you. Is it swelling of the treated area such as a hematoma, or a salivary gland leak, or an adjacent muscle that is overcompensating for a relaxed masseter muscle? These questions can only be evaluated in person with a good exam and the treating doctor knows best what area was treated.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

This swelling could be another possible issue.

Nivesh, I answered another question you posted about this concern, but this description sounds different from your other question.

Another consideration not mentioned thus far is that your parotid gland may have been inadvertently punctured and a small subcutaneous salivary cyst formed, causing the firm swelling you describe here.

IF this is what is going on, the treatment is straightforward and works well, but you must return to the plastic surgeon who did the Botox injection so the salivary cyst can be properly drained (properly is critical, as you don't want a salivary fistula draining from your cheek!)

See you doctor ASAP. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Botox for Square Jaw Reduction and Face Seems Distorted Now

 Sounds like you may have had a deep muscle bruise and or bleed from the needle insertions during the Botox treatment.  This should subside but you may want to go back and see the MD that did your Botox treatment.  Arnica 12 C is also helpful for bruising and muscle injury.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Botox in the masseters


When in doubt ALWAYS follow up with the physician that treated you.  Make an appointment to be seen so they can evaluate what may be going on.  If a portion of the masseter on one side (or both) is still too strong or contracting unevenly the area can look distorted and may just require a bit more Botox.  Injections are generally not placed as high up on the face as you described.  You may perhaps have had a deep bruise in the injected areas that may have caused some swelling and the area to look larger initially. Botox is a great tool for reshaping the jawline as well as helping patients who are chronic tooth grinders.

Good luck! 

Dr. Grant Stevens 

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.7 out of 5 stars 147 reviews

Swelling after Botox is not common - Square jaw / masseter injections are great to reshape the face

Hi,  thank you for the question.  It is not normal to see any swelling after botox.  Botox is a neurotoxin, it works be decreasing muscle activity.  In the case where we use it in the square jaw / masseter, we are decreasing muscle bulk and reshaping the face as well.  That is how it decreases the excessively square jaw.  Your botox injections would have been below the area where you are noticing the swelling.  It would be best that you see the plastic surgeon that did your injection.  It could be that you have had a great reduction in the masseter and the area above looks "swollen" in comparison.  Review of your pre Botox pictures will show this.  Alternatively, there are a number of structures that can cause swelling where you are noticing it.  A quick assessment will provide the information and piece of mind.  If he is unable to see you, see your FMD for a quick assessment.  Hopefully this information is helpful.  Dr. Scott Barr

Scott Barr, MD
Sudbury Plastic Surgeon
4.8 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.