Non-surgical Alternative to Botox for Reducing Masseter Muscles?

Question

Instead of getting rid of wrinkles, I'm trying to reduce my masseter muscles. If I'm really resistant to Botox, what other non-surgical methods could I use to reduce my masseter muscles? I already gave up chewing gum, what about wearing a mouth guard at night or massaging the muscles? Thanks!

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox or Dysport can be a very effective way to contour the jaw line by reducing the masseter shadow through the outer jaw skin.  In addition, it can reduce symptoms of jaw clenching or grinding of teeth at night time.  This is an advanced technique that requires a strong understanding of the underlying anatomy.  Some side effects can results in some very unintented effects.  This can include affecting the smile due to diffusion of the Botox into neighboring smile muscles.  Over treatment can also overweaken your jaw muscles making it harder to chew food and causes your jaw muscles to relax too much when you sleep.The injection technique does vary by physical exam and the goals of the treatment.  Facial contouring goals may change the injection sites themselves to affect different portions of the masseter as well as the dose. The strength of the masseters can be felt by palpation and also helps me to determine dosing.  In general, I start with 15- 25 units of Botox (OR 50-75 units of Dysport) per side for most patients.  If they have very strong masseters, then I may increase the dose, but more commonly ask them to return in three weeks for a touch up.  Once you get the desired result, I let patients know that future treatments may require less to maintain the look or the jaw clenching symptoms, especially if they get treated as soon as they notice the symptoms return.  This can be as soon as three to four months, but in some cases, patients report that it lasts six months or more.  I find it depends on the dose we use and how many times we have done the procedure as the duration may lengthen for patients that repeat it regularly.

Eric M. Joseph, MD · Answer

BOTOX has been shown to effectively reduce the size of your masstere muscles. This procedure is typically requested by Asian patients who wish to have a more angulated appearance of their jaw-line. I am not aware of any other non-invasive procedures to achieve the same results. If you're grinding your teeth, then a night-guard may be helpful. In that regard, consultation with your dentist may be a good idea for you. I hope this is helpful, and best regards.

Otto Joseph Placik, MD · Answer

You may want to try Dysport. It is a new FDA approved botulinum toxin that acts similarly to Botox. This would be considered an off label use. It has shown greater ability to spread locally in comparision ot Botox.

Michael Kulick, MD, DDS · Answer

Are you sure that the problem is a prominent masseter muscle??
If yes, then the other suggestions make sense.  Sometimes, the buccal fat pad can make the cheeks look fuller.  Reduction of the fat pads is an easier procedure vs masseter muscle reduction.

Tanveer Janjua, MD · Answer

You are asking an impossible question. The only solution I can think is this;
1. Stick to soft foods that require very little to no chewing. Even soft chewy foods like bagels or ganola bars can be bad.
2. Reduce the clenching of your jaw. To accomplish that during the day, buy a wrist watch that has an hourly beeping feature. It will remind you all day long to relax your jaw. For the night time clenching, 2 minutes before falling asleep do some auto suggestion, i.e., tell yourself, I will not clench in my dreams tonight. If this technique fails then see a psychotherapist to help you achieve this.
Goodluck. If all of the above does not work, don't be resistant to Botox. It is very safe and works great.
Regards

Farbod Esmailian, MD · Answer

Botox is the ideal treatment.  Not sure what you mean by being resistant to botox?  There is also another company that has botulinum toxin for cosmetic purposes call Dysport.  But you need a decent amount to botox to more over time.
Good luck.

Christopher L. Hess, MD · Answer

The masseter muscle is the major muscle that closes the jaw.  Excessive chewing, such as gum,  will make the muscle larger.  The larger the masseter muscle the more square the jaw will look.  Stopping gum chewing is a good start.  If you grind your teeth than you're going to have to see your dentist for methods to help stop this.   
Botox is the next best method.  There are no reports of "Botox resistance."  So I'm thinking that either not enough Botox is being injected, it's not fresh Botox, or the sites of injection are not correct.  
Find another person to inject the Botox.  I send my patients who desire this to an oral surgeon who is well versed in this procedure.  I'm not the best at it so I send my patients to the one who is.

Kamran Khoobehi, MD · Answer

You may want to try Botox or Dysport with another physician. The other is to shave the muscle but it is a complex and I would not recommend.

Mary P. Lupo, MD · Answer

In my experience, the masseter muscle requires a surprising amount of Botox to reshape a square, masculine jaw line. It is not uncommon to require 65 units per side (I do suggest gradual titration of the amount used, since it is easier to add more rather than subtract, and everyone is different). Dysport is too new to use in this area and most experts agree the area of effect (diffusion) may make it a less optimal product for use on the lower thrird of the face.

Steven Wallach, MD · Answer

If you have masseter muscle hypertrophy and Botox has not helped you, you may want to try dysport. It is another form of botulinum toxin that works a bit differently. Are you sure it is muscle hypertrophy and not a bony issue?

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