Asymmetrical and wide shaped face. Would masseter Botox help make my face less wide? (Photo)

Question

Growing up I had an underbite that had to be corrected twice with braces. Since then my lower face has no shape or definition. Wearing a mask during Covid gave me much more self confidence. I have tmj and was recommended to get masseter Botox. Would that help make my face less wide? Or would it contribute to the shapelessness. I am also consider double jaw surgery if that would help give my lower face structure. Losing weight didn’t work. I’m desperate to fix this.

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about your concerns, and it's understandable that you're seeking solutions to improve your facial aesthetics and address your TMJ issues. Here's some information that might help you make a more informed decision:

Masseter Botox
Botox injections into the masseter muscles can indeed help with a few issues:

1. **TMJ Disorder**: Botox can reduce the muscle activity in the masseter muscles, which can alleviate pain and discomfort associated with TMJ (temporomandibular joint) disorder.
2. **Facial Slimming**: By paralyzing the masseter muscles, Botox can reduce the bulk of these muscles over time, leading to a slimmer appearance of the lower face. This might make your face appear less wide.

However, it's essential to consider that while Botox can help with facial slimming, it may not necessarily address issues related to the overall shape and definition of your lower face. The slimming effect might make the face appear narrower but could potentially contribute to a more "shapeless" look if the underlying skeletal structure is not ideal.

Double Jaw Surgery (Orthognathic Surgery)
Double jaw surgery, or orthognathic surgery, involves surgically repositioning the upper and lower jaws to correct skeletal discrepancies and improve facial harmony. This procedure can:

1. **Improve Facial Structure**: By realigning the jaws, it can significantly enhance the definition and structure of your lower face.
2. **Correct Underbite and Other Bite Issues**: It can provide a permanent solution to bite problems, potentially improving both function and aesthetics.
3. **Address Asymmetry**: The surgery can correct asymmetries and create a more balanced facial appearance.

Given that you had an underbite corrected with braces and still feel dissatisfied with the shape of your lower face, it might be worth discussing orthognathic surgery with a maxillofacial surgeon. This could provide a more comprehensive solution to your concerns compared to Botox alone.

Considerations
- **Consultation with Specialists**: Before making any decision, it's crucial to consult with both a maxillofacial surgeon and a dermatologist or plastic surgeon who specializes in facial aesthetics. They can provide a detailed assessment of your facial structure and recommend the most appropriate treatment options.
- **Holistic Approach**: Sometimes, a combination of treatments (e.g., orthognathic surgery followed by minor cosmetic procedures) can yield the best results.
- **Psychological Impact**: Given the significant changes these procedures can bring, consider discussing your concerns with a mental health professional to ensure you have realistic expectations and are prepared for the outcomes.

Next Steps
1. **Schedule a consultation with a maxillofacial surgeon**: They can evaluate your jaw structure and discuss the potential benefits and risks of double jaw surgery.
2. **Consult with a cosmetic dermatologist or plastic surgeon**: Get their opinion on the potential effects of masseter Botox and other non-invasive treatments that might help.
3. **Evaluate your goals and expectations**: Make sure you have a clear understanding of what each procedure can realistically achieve.

It's important to take your time with this decision and gather all the necessary information to choose the best path for your needs and goals.

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