Can masseter Botox be injected higher to middle of ear instead of just up to bottom of earlobe?

Question

I have strong jaw muscles and I can feel the masseter muscle above the earlobe. Doctors usually inject the muscle up to the bottom of earlobe. Can they inject above the earlobe or will that affect smiling? I know that injecting too far forward will affect smiling, but what about injecting higher. Will that affect smiling?

Anna Chacon, MD, FAAD · Answer

Thank you for your question about masseter Botox injections. Here's some information that might help clarify your concerns:

Anatomy of the Masseter Muscle: The masseter muscle is a key muscle involved in chewing and is located at the jawline, extending upward towards the ear. Typically, Botox is injected into the lower portion of the masseter muscle, up to the level of the earlobe, to help reduce its size and activity.

Injecting Above the Earlobe: Injecting Botox higher than the standard area, such as towards the middle of the ear, is generally not recommended. This is because the risk of affecting other muscles that contribute to facial expressions, including smiling, increases. The masseter muscle does not extend significantly above the earlobe, so injecting higher might not target the masseter effectively.

Potential Effects on Smiling: Injecting Botox too high or inappropriately could impact the surrounding muscles, potentially affecting your ability to smile naturally. It's crucial to target the masseter muscle accurately to avoid any unintended effects on facial expressions.

Consultation with a Specialist: It's important to work with a skilled and experienced injector, such as a board-certified dermatologist or plastic surgeon, who understands facial anatomy thoroughly. They can assess your specific muscle structure and determine the safest and most effective injection points for your desired outcome.

I hope this helps address your concerns. Please consult with a qualified healthcare provider for personalized advice.

Philip S. Schoenfeld, MD, FACS · Answer

The reason that neurotoxins are injected at or below the ear lobe into the masseter muscle for TMJ is that the majority of the muscle belly, the most powerful part of the muscle, is at that area.  Injecting higher will only treat the thinner part of the muscle and not add anything to the result of the injection while placing the buccinator muscle and other muscles at risk that may change your smile.

Miller Vieira Paula, DDS · Answer

Yes, Botox can sometimes be injected higher up in the masseter muscle, closer to the middle of the ear, especially for individuals with particularly strong or hypertrophic masseter muscles that extend higher up. This approach may be effective for achieving more comprehensive muscle relaxation. However, it requires a skilled practitioner who understands facial anatomy well, as there is a delicate balance to avoid affecting nearby muscles that control facial expressions, such as those involved in smiling.
Injecting too far forward or into adjacent muscles could impact your smile, but injecting higher along the masseter itself, if done precisely, typically should not interfere with smiling. It’s essential to discuss this with a specialist experienced in advanced Botox techniques. They can assess your muscle anatomy and customize the injection points to safely achieve your desired outcome.

Leonard Grossman, MD · Answer

Your doctor should examine you prior to the injection with Botox and every point of a strong muscle contraction should be treated. If your masseter muscle extends higher than in a normal individual, then that point should definitely be injected. You can ask for it prior to your treatment. I hope this helps a good luck from Leonard Grossman, M.D. New York City, Plastic Surgery.

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Can masseter Botox be injected higher to middle of ear instead of just up to bottom of earlobe?

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