Botox Vs Surgery? (photo)

I have battled bulimia for the past five years.Also, For the past year and a half It has not been uncommon for me to go through an entire pack of chewing gum in the course of a day. The before picture shows the even-ness in my smile lines and shape of my jaw. The other two you will notice Uneven smiles lines, dimples, overall crooked smile. right masseter is large. and Although it does not appear this way, I weigh less now than I did in the before picture. what should I do???

Doctor Answers 12

Botox for Asymmetry

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   Botox can be used to alter the smile, but this is not typically done on a patient without facial nerve injury or history of nerve injury.  Fillers may help with some of the subtle lines on the right.

Botox for Uneven Smile

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Botox can be used to improve symmetry of the smile and masseter hypertrophy. When used in small doses, over time, a nice symmetry can be achieved. Improving the cause of the masseter hypertrophy can help as well. Botox is a quick easy fix though in the mean time.

Botox and masseters

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Botox injected deep into the masseter muscle will decrease it in size and strength - with consecutive treatments to achieve a desired symmetry. Consulting with a well-trained and experienced injector should give you all the information you need, both surgical (if you're even a candidate) - and non-surgical options.

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Botox vs surgery for jaw line

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As all of the others stated, you are quite beautiful and it's usually ourselves who are the very most critical. Could you have Botox to the jaw muscle that is a tiny bit larger? Sure. Is it necessary? No. Would I recommend surgery? Not a chance. Every single person has a bit of asymmetry and it's what makes us human. If you decide that you want to do something - because it is going to make you more comfortable with how you look and your confidence - and not because it's "necessary", then consult with a few physicians. If possible bring in before photos of you smiling, not smiling, etc. It's important for someone to evaluate various facial movements and structures. Though I'm sure you smile quite often, your face at rest also needs to be accounted for in how any treatments are done or considered.

Approaches for treating mandibular/lower face asymmetries

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Given your history of bulimia, the asymmetry of your jawline is likely due to three factors: parotid fullness, masseter hypertrophy, and bony contour asymmetry.  Undergoing appropriate treatment for bulimia will help to address the swelling of the parotid glands that occurs with the disease and with constant gum chewing.  

Regarding the final two - Botox injections for masseter reduction is virtually painless, quick, and non-invasive with no downtime.  Start with things that are easily correctable.  If it does not give you satisfactory symmetry, then you can start to explore more aggressive and invasive options.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Botox for masseter

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Botox is definitely the easy answer. Surgery for reducing masseter is quite invasive and has long recovery. If you keep doing Botox regularly it might reduce the need for frequent injections.

Also, keep in mind that you need to find out from your dentist if you have any dental or TMJ issues that would contribute to the enlarged masseter.


Dr. J

Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Botox vs. Surgery for masseter swelling

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Although Botulinum toxin is a good treatment for masseter muscle hypertrophy (overgrowth), there are some known side effects with weakening of this muscle with neurotoxin.  Botox, or other toxins are not a good treatment for lower facial asymmetry, as the asymmetry is usually bony.  In any case, I would clearly advise diagnosis and therapy for your eating disorder  with a professional before receiving any cosmetic treatment.

Surgery vs Botox

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Though I'm sure you've heard it hundreds of times, you are clearly very beautiful as you are and I wish you much success battling bulimia. 


As for your face, I see what you are referring to on your right hand side, but I don't think 99.9% of the world would notice it if you didn't specifically bring it to their attention. What I tell any of my patients who have a complaint about their face when they make a certain expression (like a smile) is that we cannot treat the face for these expressions, because it will make your face look bizarre when you're not making that expression. It simply won't work. Instead, I recommend cutting back on the chewing gum to stop stimulating your salivary gland and causing it to become hyperplastic. 


Best of luck with everything. You are young and beautiful and don't need anything done cosmetically. 

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Agree with above

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Drs Herzog, Kontis and Swengel are right. Natural beauty is in itself asymetric. Bulimia, as you know as caused the swelling of the parotid and salivary glands, and the side that is larger should go down as long as it is not stimulated much. Your glands are getting activated by chewing gum also that can cause some increase in size on that side- cutting back on gum (and sour candy etc) may be a good idea.

Botox for assymetry

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I agree with the others and would not have surgery nor would I use Botox at this point. You are beautiful and have a wonderful smile. No person is perfectly the same on both sides and when you are talking to someone and moving it is not like a snapshot where you catch this asymmetry and focus on it.I have one question. Do you chew all of your gum on one side? This can cause muscle growth and probably problems with your teeth so if you are a one sided chewer try the other side. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.