Masseter Botox and now my cheeks have sunken and I'm only 27!

I had 12 units (each side) of botox on my masseter on Feb and 1 more on june. Now is august. my jaw has dramatically thinned but now I've sunken cheeks and slightly droopy despite my age. I even gained a few lbs since the procedure. Is it possible that the doc injected at the wrong place? My sister had the same procedure w diff doc and hers were done just slighly under the jawline. mine while still on my jawline, they were slighly above where hers were done. Hers look great! Any suggestions why?

Doctor Answers 5

Botox and Bruxism

Hi there

Sorry about your problem you are experiencing.  More information and before and after photos would help to make a better assessment.  it would be unusual to have such a dramatic change from Botox.  There could be something else going on.  Best to see with your injector what is going on and see if it is related to the Botox.  

Good Luck


It's possible that your masseter muscle has decreased in size and resulted in your cheek now appearing sunken. It is best for your to consult with your injector and your primary care physician to determine whether what you are describing is indeed from the Botox, or from another medical condition causing accelerated tissue wasting.

Ava Shamban, MD
Santa Monica Dermatologic Surgeon
3.9 out of 5 stars 9 reviews

Botox and the Masseter

I agree with the response given here.
Not only can we not answer your question without good pictures, but what you are describing demands a real time exam.

I would seek an opinion from another physician, one qualified in masseter injections.

Sorry that we cannot be of more help here.

Michael A. Greenberg, MD
Elk Grove Village Dermatologist
4.9 out of 5 stars 16 reviews

Masseter botox

If you want a real response from doctors on this forum, you need to post before and after pictures as your description is not consistent with what you describe. You may need to see your doctor about a serious medical condition as the amount of botox you described will not do what you claim. Also, masseter botox is not injected below the jaw line. Masseter muscle is above the jaw line and sits at the angle of the jaw where its hypertrophy leads to widened appearance of face.

Edwin Ishoo, MD
Winchester Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Masseter Injection

Everybody has different responses to Botox and the number of units to achieve the desired results.  So it is difficult to compare the exact amounts patient to patient.  As for injection site, physicians will use different sites depending on what they are targeting and what they feel comfortable with regarding the surrounding anatomy.  The masseter is a large muscle and therefore can be injected in many places.  

I assume you had your muscle injected for aesthetic reasons to narrow your face.  The Botox paralyzes the muscle and then since it is not being fully used the fibers atrophy or shrink giving you the desired result.  Everyone responds different and it is difficult to know the exact amount needed to paralyze enough muscle to shrink it but not over do it.  Starting off with smaller injections are a good way and then waiting to see the desired result.  Remember, it takes 5-7 days for the Botox to work then a weeks for the muscle to shrink from being paralyzed.  In your case that the muscle has shrunk more than you want, you just have to wait for the Botox to wear off and then begin building muscle back (exercising it by chewing), but remember like any other muscle on your body this takes time to rebuild.  If you want volume faster, consider a temporary soft tissue filler to add volume until it improves. 

Robert Paul, MD
Indianapolis General Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.