Why Didn't Botox Work on my Masseter Muscle?

I have had botox injection at my both cheeks November last year , but so far it does not really show any effect. I put a lot of hope in it and thought I would get rid of the square face, but I ended up with frustration & disappointment.

Does anyone know why Botox does not work on me? I wonder if the masseter muscles at my jaws are too large and I wonder if I shold take higher dose of Botox injection to get effects. Please give me some advises and ideas. Thanks.

Doctor Answers 10

Botox treatments are technique dependent

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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.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox for masseter injection.

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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.

Botox Masseter Ineffective

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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.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

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Botox and Masseter Muscle

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Botox works very well in slimming the face and reducing the chubby look of the face. A photo is needed to evaluate whether or not Botox would have been the best treatment for you. It's best to consult an expert in Botox. Best, Dr. Green

Botox on Masseter Muscles

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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 and masseter muscle

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Botox is thought to help reduce the size of the masseter if they are hypertrophic. However, a single set of injections will not do the trick, this may take repeated treatments over a year or more.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

How to use Botox for the jaw muscle

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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.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Sometimes it takes a lot of Botox

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I have used as much as 60 units per side in strong masseter muscles to reshape the lower face. If you did not get a response, get more units.


Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Probably did not get enough Botox

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HI!  The masseter muscles are very big and can rquire as much as 50 units per side.  Asian faces also require more Botox. Finally, the technique is very important.  You have to inject it in just the right spots.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Botox for the masseter muscle

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It takes about 6 months to see any difference in the contour of your jawline. Botox should be administered every 4 months for 1 full year to obtain the full effect on the Masseter muscles. Also, it takes about 30 units of Botox per side. You may wish to find out from your injector how many units of Botox were used. Also, you ought to consult with a facial pastic surgeon or similar practitioner with a good understanding of facial anatomy and areas to avoid (for example the Parotid gland).

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

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.