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.

Thank you for your question! I'm sorry to hear your treatment has left you disappointed. When treating the masseter muscles with Botox it can take up to 30 days to see any slimming effect, as the muscle requires time to shrink in size (atrophy). The amount of slimming seen varies patient to patient and depends on the dose of Botox used and how strong/large the muscles were initially. Many patients require multiple treatments before reaching desired results. It is also important to compare before and after photographs as this best represents results. 
I created a video that reviews using Botox to slim the face. I hope you find this information helpful in your research!

Thank you for your question Chubby face. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Depending on the reason for the enlargement of the muscle, permanent results may be achieved. For example, some people have a habit of grinding, clenching, or biting their teeth subconsciously. Often times this happens in their sleep when they are not aware of it. Botox placed in this muscle will relax the muscle and the grinding, clenching, and/or biting will decrease. This will reduce the size of the muscle. If the brain gets accustomed to this and the person stops grinding, clenching, or biting, then the muscle will not become enlarged or as enlarged again. However, if the habit starts again, the muscle will likely get larger.
To determine if someone is a good candidate for this treatment it is necessary to look at a person’s lower face when biting and comparing it to when the person is not biting. If a bulge is seen on the outer portion of the jawline, then the person is likely a candidate. It can also be felt with the fingers when biting.
If I had a patient with the concern described here I would want to look at her skin to make an assessment as described above. It is possible that there is not an enlarged masseter muscle and she would thus not be a good candidate for the treatment discussed above, which may explain why she is not seeing results.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

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 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.

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.
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