Facial deformity after masseter Botox. What went wrong? (photo)

Question

It's been 24 days since I had 50 units of Botox injected into each masseter to reduce teeth clenching and soften the jaw line. I'm losing definition and symmetry in my cheeks by the day. Also, my smile is weaker and uneven. In the photos, my smile crease is receding, I assume because the muscles there are overcompensating. One cheek is higher than the other. I know Botox will wear off eventually, but will the deformity get worse as the muscles continues to atrophy? Was the dosage too high? Help!

Kenneth D. Steinsapir, MD · Answer

This effect will resolve with time.  However it will be 6 months. The muscle atrophies and one sees less volume there.  That is precisely the effect of the treatment.  You are already at the maximum effect of the treatment. Now things will stay the same for a couple of months before gradually wearing off. Don't repeat the treatment.

Jason Emer, MD · Answer

This will eventually resolve in 3-4 months. In the meantime, Venus Legacy/Thermage treatments may help give improvement. See an expert. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry to hear of your Botox side effects.  Botox can effectively reduce masseter hypertrophy and teeth grinding by weakening the muscle through atrophy.  This can cause the feeling of weakness as your chew.  Botox placed for this reason should be along the jawline and away from the muscles/nerves responsible for smiling and I would reassess your injectors placement of the botox in any future treatments.  As you mentioned, Botox's effects are temporary and will resolve over 3-6 months but as your muscles continue to atrophy you may continue to see some asymmetry until it stabilizes.  Hang in there!

Mark Kearns, MBChB, BSc, FRACGP · Answer

It was a large dose in botox units. Was it Dysport instead of botox at all? If so the effect shouldn't get too much more pronounced and should fade in the next 3-4 months. If it was botox it may last longer.

Monika Soni, MD · Answer

Thank you for your question! It seems to me that too much Botox was injected. It has been longer than 3 weeks and you should be able to see end results by now. I would advise you to have a check up appointment with your injector and see what s/he says. I would suggest you to choose experienced providers who will guarantee best end results after your Botox injection. This will wear out in 3 -4 months. Hang in there. Best of luck!

Hardik Soni, MD · Answer

It seems to me that too much Botox was injected. It has been longer than 3 weeks and you should be able to see end results by now. I would advise you to have a check up appointment with your injector and see what s/he says. I would suggest you to choose experienced providers who will guarantee best end results after your Botox injection. This will wear out in 3 -4 months. Hang in there. Good luck!

Richard A. Zoumalan, MD · Answer

Botox to the masseter is a great way to help with clenching and softening the jaw line. I would address these issues with the person who injected you, as they would be able to best assess your situation

Reza Tirgari, MD · Answer

I agree that the amount was probably too much.  Also, I would inject slightly more into your dominant side and less into the other.  An experienced injector can tell the difference.  Either way, it will resolve on its own with time.

Steven Wallach, MD · Answer

The effects of the botox will last 3-4 months. Injecting into the masseter should not affect your smile unless you clench when you smile.

Kristin J. Tarbet, MD, FACS · Answer

Thank you for posting pictures for evaluation. It appears that the botox is the cause for your concerns. I would consider asking your injector to lower the dose at your next treatment.

Facial deformity after masseter Botox. What went wrong? (photo)

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