Face Seems Bigger and Distorted After Botox for Square Jaw Reduction?

Larger cheeks, or jaw lines that are not sharp might be caused by hypertrophic or enlarged hypertrophic muscles. This is not to say that all large cheeks are caused by this.  Botox injections can relax the enlarged muscles and create a thinner lower cheek but if adjacent muscles also relax, there might be an undesired consequence of unrelated muscle weakness, drooping of adjacent tissues and an unwanted change in contour. 

Botox for this condition should be done by experts, such as ENT doctors. Some doctors have a forte in dealing with TMJ, a joint problem of the jaw, and they may be expert in injecting different chewing muscles. It is important to see an expert as asymmetric treatment or asymmetric results can cause an imbalance that may create a more side-to-side movement when the jaw closes than the desired up and down motion. The side-to-side clenching may exacerbate a TMJ syndrome.

Thanks for the question. Jawline reduction by injection of Botox or Dysport into the masseter muscles is a treatment I perform quite commonly in my office. This is a wonderful treatment for making the jawline slimmer and it takes approximately 5 minutes to perform in the office. I inject between 20 and 40 units per side. The idea is that the muscle is weakened mildly such that it shrinks in size. This is an advanced technique of Botox/Dysport injection so it should be performed by physicians who are very knowledgeable and experienced in dealing with the anatomy of the muscles of the face and the bite muscles. The depth of injection is extremely important to avoid affecting your smile. 

The effects seem to last 4-6 months at first but over time, my patients are generally able to break the habit of clenching and grinding and can go as long as a year between sessions. This treatment also works well for bruxism (teeth grinding) and is an excellent option for those who have tried mouth guards and either can't wear them or continue to clench and grind with them in place. It's a bit hard to tell from your description (without a physical examination) what is happening with your masseter muscles so I would definitely recommend returning to see the physician who treated you. 

If the bulge is larger when you chew or clench, it is possible that the muscle may have been undertreated or treated unevenly, such that the portion of the muscle which did not receive Botox is working harder and becoming hypertrophic. Because the masseter muscles are so much larger and deeper than the muscles in the forehead or around the eyes, the possibility of uneven treatment is a bit higher. You may just need a touchup of a few additional units on the side with the bulge. However, if the bulge is the same size regardless of biting or clenching, this could indicate a parotid or lymph node issue and you should have this evaluated by a facial plastic surgeon or ENT.

Best regards,

Dr. Mehta

The masseter muscle is treated for square jaw reduction.  This muscle is below the parotid gland.  Because of this, an injection must go through this saliva gland to reach the muscle and complications can occur including infection, injury to the saliva duct or hematoma.  These should all be short-lived, so continued symptoms after months should be concerning.  If your physician is a facial plastic surgeon, I would recommend going back to them for evaluation.  If not, then you should find an ENT.