Masseter reduction. What is the needle length to use for the masseter?

Question

The doctor I work for is going to inject my masseter for bruxism. This would be her first time doing this. She is a dentist. What is the needle length to use for the masseter being that it is a large muscle? I believe the needle would need to be longer but is 1" sufficient? The previous times I have had this done the surgeon injects in three locations on the muscle. Is this a necessary technique or can one put all the units in one location? I typically have 40u per side. Thanks in advance.

Stephen Weber MD, FACS · Answer

I would strongly recommend being treated by someone more experienced. I have seen numerous complications (imagine "stroke like" appearance for 6-8 weeks) when uninformed injectors attempt to treat the masseter. This is not worth the risk to you. A 1" needle is way too long in my opinion.Stephen Weber MD, FACS

Nima Shemirani, MD · Answer

Hi @wannabyoung! I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. I use a 30 g 1/2 needle. Best of luck, Dr. Nima!

Gregory A. Buford, MD, FACS · Answer

I have used this technique for several years to help my patients reduce jaw grinding, improve symptoms of TMJ, and (cosmetically) reduce the size of their masseter muscles.  But, as Dr. Weber points out, this is not an injection that should be performed by someone with little experience.  Instead, I would also suggest that you seek out someone who has performed this procedure several times before.  
As for the needle, I generally use a 32 gauge 1/2 inch and inject BOTOX units as I see fit based upon my patient's symptoms.  
I hope that helps!  Please let me know if I can help.

Jeffrey R. Raval, MD, FACS, MBA · Answer

A one inch needle is more than sufficient. I typically use a needle that is only 8 mm long. Using multiple locations works best for me as well. Finally, 40 units per side is a little on the high side in my experience. Have you tried a lower dose say 25-30 per side?

Thomas Balshi, MD · Answer

I agree with Stephen Weber, M.D., a one inch needle is way too long. My preference is a 30 gauge half inch Turmo needle.  I like to inject each muscle in four locations, placing about 10 units per injection.  The procedure is often very well tolerated by the patient with little discomfort.  Result begin in a few days, but unlike Botox in say the forehead area, it usually takes a couple weeks to see a true reduction in the size and strength of the muscle.  The Masseter is one of our strongest muscles.  Good luck

Masseter reduction. What is the needle length to use for the masseter?

Answers (5)