How Can I Correct Joweling from Botox for Masseter Hypertrophy?

Question

I have had botox treatments for over developed masseter muscles and have seen signicant results with the slimming of my jaw area. Although I have seen improvement, I have also noticed slight joweling forming around my mouth. I was wondering if it is the injectors technique that is botching the potential results of a good product or if is the loss of volume and scaffolding that is making my skin sag and thus making my once youthful face look more tired and aged. Is there a way to prevent this?

Ron Shelton, MD · Answer

Depending on the muscles of the cheek that were affected by the treatment, there might be relaxation of the elevators of the lower cheek/jaw. There might be an appearance of sagging. Should this occur, then ultherapy, focused ultrasound, could be used to provide a non-surgical lift (although not as much lift would occur compared to a surgical lift). In addition, volume augmenation may help by doing fat injections, Sculptra, Radiesse, Perlane, etc.

Kenneth D. Steinsapir, MD · Answer

Stop getting this treatment. It may take 4 months for the effect to resolve. If you are not certain and you are not sure of your injector, consider getting a second opinion. Masseter BOTOX should not cause a jowl.

Harold J. Kaplan, MD · Answer

It would seem that you are observing the intended result - debulking of the Masseter muscle.  However, it's not unusual to observe other changes as a result of the primary goal or because a patient becomes more attentive to their appearnace.  

	In any event, using cosmetic dermal fillers to restore volume to the area you are describing is an excellent option for shaping of the lower face.

	Be certain to discuss your concerns with your injector so that you may know your options.

Will Richardson, MD · Answer

Skin tightening procedures such as ReFirme or Ultherapy would be an excellent possibility for correction. Certainly, as recommended, avoid further injections.

Francis R. Palmer, III, MD (retired) · Answer

IMHO, it's most likely the loss of Masseter volume and there's no way aroud that. You can have some Perlane in the marrionette line (fold in front of the jowls) or a minimum incision Face Lift to tighten the SMAS, Jowls and remove excess skin, I'd have to see photos of the Jowls to determine which was more appropriate in your particular case.

How Can I Correct Joweling from Botox for Masseter Hypertrophy?

Answers (5)