Why Didn't Botox Work on my Masseter Muscle?

Dear Chubby,
Masseter BOTOX treatments take a few weeks to be seen. Occasionally, a before and after photo comparison is needed to really understand what if anything was accomplished.
One issues is whether the fullness of your face is from muscle or primarily fat. Muscle responds to BOTOX but not fullness from fat. In which case, facial liposuction maybe beneficial.
The next issue is dose. I recommend that you do your homework and find the leading physician doing these treatments in your area. You may pay a little more for a visit with them but then you are much more likely to achieve your goal.

Thank you for your question. Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep. Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox wears off completely.This region is considered a more advanced technique, so I would make sure you go an experienced injector.

I would wait 14 days to see your maximal result. Each muscle group
responds differently, so it may just take more time. However, it is also
possible that you need more Botox injected to have the
effect you want, and this could be determined at your followup appointment with your injector. You may require a higher dosage as you suggested, or the right muscles were not targeted.

Botox injections to the masseter are tailored to each patient.  There are several reasons why your treatment may not have been effective:

"Imposter Botox"  - There are several versions of botulinum toxin available.  In the United States, two are currently FDA approved, Botox and Dysport.  Beware of other versions of Botox which may be counterfeit, watered down, or "Chinese Botox" which has a track record of unreliable results.

Poor technique- Botox must be injected into the proper location of the masseter muscle.  

Not enough units-  Every patient has a differnent dosage requirement and the treatment must be tailored to your anatomy

Followup treatments- Botox jaw reduction requires a series of treatments with each treatment creating more impact than the previous treatments

Poor Habits-  Patients who continue to chew gum, eat chewy foods, etc, will lead to less impressive results after treatment.

As the other panel member suggested, there are two main factors that may have led to disappointing results.  First and foremost, it would appear that you did not return for subsequent treatments after your initial visit.  Most practitioners will want to re-dose the area within four months of the first treatment.  It's not unusual to have 3 treatments within the first year to achieve optimal results. 

The proper amount of dosing (we start at 25 units each side and titrate up as needed) is vital in relaxing a rather large muscle. 

We would encourage you to not give up on your treatment goals as most patients that undergo this seem quite satisfied with the outcomes.  Do your research and find a practitioner that has experience in this technique and is able to produce before/after photos.