Will muscle atrophy from Botox be permanent after multiple treatments?

Question

I want to use Botox (20 units) on my left masseter muscle as it is much bigger than my right masseter muscle. However, I keep reading that the atrophy effects from the injection are not permanent and my masseter will return to its original size after 3 or so months. BUT, my doctor's PA says after 3 treatments the effects will be permanent. Is this true? Thank you

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  Assuming the underlying reason for your masseter hypertrophy remains, once Botox wears off the muscle will enlarge to its previous size, regardless of which treatment number it is.

Deborah Kessler Hudak, MD, MHA · Answer

The correct answer to your question is that noone can guarantee you will get "permanent" muscle atrophy of a repeatedly neurotoxin-injected muscle. (Examples of neurotoxins are Botox, Xeomin, and Dysport.)  One can certainly expect some atrophy of a muscle that is not contracting due to being repeatedly injected prior to the muscle getting back its full strength....but the degree of atrophy will be dependent on the amount of neurotoxin injected relative to the amount needed for near-complete muscle relaxation, as well as the frequency of getting injected, as well as the frequency of the habit of yours to contract that muscle fully or partially.  Muscles get bigger when they are being "worked out."

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Colt8. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Botox can be placed in the masseter muscle in the lower face to contour the lower face and address pain associated with TMJ. In this area 20-40 units of Botox are used per side. Depending on the reason for the enlargement of the muscle, permanent results may be achieved. For example, some people have a habit of grinding, clenching, or biting their teeth subconsciously. Often times this happens in their sleep when they are not aware of it. Botox placed in this muscle will relax the muscle and the grinding, clenching, and/or biting will decrease. This will reduce the size of the muscle. If the brain gets accustomed to this and the person stops grinding, clenching, or biting, then the muscle will not become enlarged or as enlarged again. However, if the habit starts again, the muscle will likely get larger.
  
To determine if someone is a good candidate for this treatment it is necessary to look at a person’s lower face when biting and comparing it to when the person is not biting. If a bulge is seen on the outer portion of the jawline, then the person is likely a candidate. It can also be felt with the fingers when biting.
With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Kamran Khoobehi, MD · Answer

After using Botox for many years for facial expression muscle, I have not seen permanent results. Please consult with board certified plastic surgeon or dermatologist for evaluation and treatment.

Kristine Brecht, MD (license suspended) · Answer

Dear Florida,Botox doesn’t last forever. With more treatments the muscle does loose its flex longer, but when you stop Botulinum, any muscle can be strengthened again over time.Best. Dr Brecht Seattle, Wa

Will muscle atrophy from Botox be permanent after multiple treatments?

Answers (5)

Answer: No permanent results

Answer: No permanent results

Answer: Botox doesn’t last forever

Answer: Botox doesn’t last forever

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.

Will muscle atrophy from Botox be permanent after multiple treatments?

Answers (5)

Answer: No permanent results

Answer: No permanent results

Answer: Botox doesn’t last forever

Answer: Botox doesn’t last forever

Browse related questions

Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.