Why is Botox in masseter creating jowls with muscle spasm after 6 weeks? (Photos)

Question

2 weeks after Botox in masseter (20 units left & 25 right) for TMJ I started to get muscle spasm around chin and jowl area. After 6 weeks, my contoured oval face is now flat with a ‘pulling’ in right jowl area. Feels like there’s a trigger point on jawline around DAO/lower cheek area. My temporalis has hollowed after 15 units. Surgeon said he could put Botox in DAO & platysma to stop the spasm; he promised my face wouldn’t slim after Botox and it has!!! Should I try acupuncture?

Jason Emer, MD · Answer

This isn't typical. I recommend following up with your injector. Botox results will resolve in 3-4 months and can be softened with venus legacy treatments. Best, Dr. Emer

Shaun Patel, MD · Answer

It is possible that a portion of the masseter muscle was left untreated and that you are noticing this contraction as a "spasm". The best thing to do is followup with your injector for an in person evaluation. If there is still a portion of the muscle that is contracting, a small amount of Botox or Dysport will be able to treat this.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs verinaversace. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. 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.If I had a patient with concerns as described here I would recommend that she return to her provider to discuss her concerns. When Botox is used in the masseter muscle there is a possibility and likelihood that the lower face will slim down.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!

Why is Botox in masseter creating jowls with muscle spasm after 6 weeks? (Photos)

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Why is Botox in masseter creating jowls with muscle spasm after 6 weeks? (Photos)

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