Botox in the masseters gave me jowls. What can I do? (photos)

Question

My jaw looked better before Botox, now I have jowls. It did help with my grinding but now I have another problems. Very unhappy.

George Yang, MD · Answer

Hi Joengland, So sorry about what happened. In general, I worry about my patients over 35-40 who get botox or other neurotoxin to the masseter muscles for grinding of the teeth (Bruxism.) It will help with the grinding, but may result in a secondary side effect of jowling if the dose is too high, or even just right to treat the grinding may cause this to happen. Luckily the masseter muscle can rehypertrophy meaning it can grow and fill out replenishing the volume to the jaw angle area. 
Some patients may request a jaw angle filling using hyaluronic acid like Restylane or Juvederm to build back the jaw angle volume, but I advise them to wait if they do not plan to do botox in the future. If the like the botox effect for the bruxism, and potentially some headache triggers prevention, then they may want to do the botox again. If this is the case, I would inject the Restylane or Juvederm, under the SMAS, and over the atrophied masseter to recreate the volume lost. 
Be careful about allowing your weight to change if you are depressed about the situation. In your before photo, your under chin area did not look as full. Simply shrinking the masseter with botox should not create too much of a double chin, so just be careful with your weight, especially if this is causing you a lot of stress. We don't want the one problem to compound into other problems.
Please don't compound your problems with additional procedures before the botox effect has fully worn off. Kybella to the jowls can cause a temporary weakness/paralysis to the marginal mandibular branch of the facial nerve that can run around the jowl area. Since Kybella can dissolve fat, the insulation around nerves is also made of fat, so be careful with advice you get from the internet.
Hope you found my comments helpful. Best, Dr. Yang

Camille Cash, MD · Answer

I'm sorry you are unhappy with your masseter Botox treatment.  The effects from Botox will wear off gradually over the next three to four months and you should return to your pre treatment appearance.  You can also consider fillers for facial contouring if you like the other effects from the Botox and would like to repeat the treatment.

Jonathan Kulbersh, MD · Answer

Hello and thank you for your question. Botox is generally a safe procedure and an effective jaw contouring treatment. However, depending on the patient’s unique facial structure and degree of skin laxity, jowls may form. In your case, it is possible that the loss of muscle tone in the masseter may reduce the tension that was supporting the skin around the jawline. In other words, a smaller masseter will cause existing loose skin to slide downward.

You may also have been given a higher dose of Botox than necessary. But don’t worry. The effects of Botox wear off within 3-4 months after treatment. In the future, I recommend seeking treatments from reputable facial plastic surgeons, especially those with extensive experience with injectables. These experts not only have the knowledge and experience necessary to safely perform Botox treatments, but they have the aesthetic eye to produce natural-looking results. You may schedule an in-person consultation to have your face evaluated, allowing your doctor to design the best treatment plan (possibly dermal fillers) to restore volume around the jawline.

Jason Emer, MD · Answer

Botox results last up to 3 to 4 months and can be softened with Venus Legacy and Thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Eric M. Joseph, MD · Answer

Do you know how many units of Botox you received? We have not seen such dramatic reduction in the size of masseters, and we use around 50u per side, depending on the condition. This will completely wear off in 3-4 months, and should not have sequelae. Hope this helps. Dr Joseph

Botox in the masseters gave me jowls. What can I do? (photos)

Answers (9)

Answer: Unhappy with Botox Results / Distorted Smile -- add Venus Legacy, Thermage, See an Expert

Answer: Unhappy with Botox Results / Distorted Smile -- add Venus Legacy, Thermage, See an Expert

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Answer: All effects of Botox dissipate…

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Botox in the masseters gave me jowls. What can I do? (photos)

Answers (9)

Answer: Unhappy with Botox Results / Distorted Smile -- add Venus Legacy, Thermage, See an Expert

Answer: Unhappy with Botox Results / Distorted Smile -- add Venus Legacy, Thermage, See an Expert

Answer: All effects of Botox dissipate…

Answer: All effects of Botox dissipate…

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.