Masseter Botox - ruined face / smile. Options? (photo)

Question

I had massater Botox done theee times due to extremely large muscles. It appears all the skin and tissue has drooped down my face and beside my smile . I have a chipmunk look and a shorter looking chin now : scared I’ll be like this permanently

Anna Chacon, MD, FAAD · Answer

I'm sorry you're experiencing this. Changes in your facial appearance after masseter Botox can be unsettling, especially when they affect your smile or make your face look different than you expected. The good news is that, in most cases, these effects are not permanent.

When the masseter muscles become significantly smaller after Botox, the surrounding soft tissues may lose some of the support they previously had. This can make the lower face appear fuller or heavier, sometimes creating what's commonly described as a "chipmunk" or "jowling" appearance. In some individuals, the chin can also appear shorter or less defined because the overall balance of the lower face has changed.

Another possibility is that some of the Botox affected nearby muscles involved in smiling. If that occurred, it can temporarily alter your smile or create facial asymmetry. Fortunately, as the effects of Botox wear off, muscle function gradually returns.

Botox typically lasts 3 to 4 months, although if you've had multiple treatments, it may take a bit longer for the masseter muscles to regain their previous size and strength. Even then, the muscles usually recover gradually over several months. It is uncommon for these changes to be permanent from Botox alone.

Whether additional treatment is helpful depends on the underlying cause of the changes. If the concern is simply loss of muscle volume, allowing time for the Botox to wear off is often the best approach. If there is noticeable soft tissue laxity that persists after recovery, treatments such as dermal fillers, collagen-stimulating injectables, skin-tightening procedures, or other contouring techniques may be considered depending on your facial anatomy and goals.

For now, I would avoid receiving additional masseter Botox until your facial contours have had time to recover. Taking serial photographs every few weeks can also be helpful, as gradual improvements are often easier to appreciate when comparing images over time.

The reassuring news is that what you're describing is a recognized effect of masseter Botox in some patients, particularly those with larger muscles or significant muscle reduction after repeated treatments. While the changes can be frustrating, they are usually temporary, and facial balance often improves as muscle activity and volume gradually return.

Camille Cash, MD · Answer

The effects of Botox are temporary, typically lasting three to four months.  You can consider fillers to help restore volume and improve facial contours.  See an expert injector near you to learn more.

Masseter Botox - ruined face / smile. Options? (photo)

Answers (2)

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