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

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

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.

Jennifer Scaljon, MD · Answer

The loss of muscle tone and volume in the Masseter Muscle has taken away the tension that was holding up the skin laxity around your jaw line. As the botox wears off and the muscle becomes stronger, you will see an improvement. But, another option would be to create collagen growth in other locations to pull up that lax tissue. For example, Sculptra to the cheeks and pre-auricular area would give contour to your cheeks, while also budding collagen in those areas. That collagen would act as a support system to pull up the "jowl area." Cheek filler, with a hyaluronic acid filler, could do the same thing.

Kurt Kuhlman, DO · Answer

You probably had a high dose of Botox given in your masseter muscles. They will enlarge over time.You could receive a small amount (0.5 cc per side) of Kybella injected into your jowls two times over the next month to help reduce your jowls.

Darryl J. Blinski, MD · Answer

Appears the masseter Botox injections were over treated causing the masseters to flatten out. I might try injection of KyBella in diluted amounts into the jowls or in combination with a mini anterior facelift.

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. We would always recommend a face to face consult however in this case the best option would be to let the botox wear off 4-6months and reassess. You could have treatment before then but your face will change again as there toxin wears off so better waiting then before treating.
We hope that answers your question. Best wishes

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

Answers (9)

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