Botox or Filler for uneven cheek? (Photo)

Question

I have a very slim face on the left side and a cheek that looks hollow. By contrast, the right side looks bigger and fuller. I’m wondering if it’s possibly caused by a larger masseter muscle on the right side and if this can be fixed with Botox? Or would it be better to just put filler on the left side to plump it up a bit?

Nelson Lee Novick, MD · Answer

The use of Botox for the right masseter, in my opinion, would likely lead to an overly narrow lower third of the face. At least from the photo, it would appear that the use of an appropriately robust volumizing HA filler placed in the region of the posterior angle of the jaw and extending outward to the cheek would provide the necessary symmetry. You would be wise to consult with an experiienced, board certified cosmetic dermatologist filler injector. Hope this helps and best of luck.

Giancarlo Zuliani, MD · Answer

Many times a combination of both treatments will help to enhance or correct the areas of concern. In your case I would recommend filer to the anterior cheek, this will give volume to the cheek and lift the face as well as improve the appearance of the under eye region.  Botox in your masseters will help to reduce the muscle and slim the face.  Hope you find this helpful.

Anil R. Shah, MD · Answer

Hello Affectionate868747! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. Thank you for your question. Based on the image, I recommend using a dermal filler on the left side of your face to add volume to your midface and help with cheek symmetry to achieve more aesthetically pleasing results. I hope this helps and best of luck!

Brian Bassiri-Tehrani, MD · Answer

This is a good question. Based on the photo, it does not appear that you have an enlarged (or hypertrophied) masseter muscle on either side because your lower face is narrower than your midface - which is ideal (think of a heart shaped face). Because of that, I would not recommend injecting toxins in your masseter muscle; furthermore, if you inject toxin in your masseter muscle without it being too big/overworked, without symptoms of grinding your teeth, you may notice fatigue when chewing and eating. Instead, I would recommend using an HA (hyaluronic acid) filler to augment your midface, putting more filler on the left side to balance and help with symmetry. This should help with the overall harmony of your face. I hope this helps.

Eric M. Joseph, MD · Answer

You are correct that the asymmetry in your cheeks may in fact be from your masseter muscles! The only way to determine whether or not you would benefit from Botox or a filler is to be examined by a reputable facial plastic surgeon or cosmetic dermatologist. I hope this helps! Sincerely, Dr Joseph

Brandon Richland, MD · Answer

Hello, and thank you for your question. In general, all faces are asymmetrical. This can be due to anatomy, sleep position, volume loss, etc. If you potentially have a larger masseter muscle, this can be due to anatomy, teeth grinding, or clenching of the jaw, Botox would help reduce the volume of the masseter muscle, which can give a more contoured appearance to the face, accentuating cheek structure. Filler can also be applied to to any hollow areas to potentially provide volume to restore the structure that we lose as we age. Cheek filler is a great option for patients that have lost medial cheek volume or lateral cheek volume. Cheek filler can be placed in different areas to achieve a specific look. The only way to determine if filler or Botox is a better fit is to see a practitioner who specializes in administering these injectables.

Jason Emer, MD · Answer

This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. Buccal fat pad gives slimming not symmetry. Masseter botox will make you slimmer and make the jawline more loose. Fillers help give shaping and contouring. If you want perfect or close to perfect symmetry you need maxillofacial surgery or implants customized. I suggest seeing an expert to go through all options. Most of my younger clients use fillers to give them shaping especially on the cheeks, jawline, and chin which make the face look more slim and tight; and threads such as PDO or Instalift can build collagen and support the facial shaping and skin looseness over time, slowing down the aging process and given the face a more “snatched” look; and morpheus8 or PiXel8 deep microneedling RF can tighten crepe skin especially on the neck and jawline and is great for long term tightening of the full face, neck and chest; its often used to give the face a slimmer more sculpted look because it tightens the skin and gives lift. an early face lift can be performed as well even in younger clients if they want a different facial shape, maxillofacial surgery with bone breaking or shaving can also be done. For facial slimming a combination of treatments are always needed. Options include: 1. Buccal fat pad removal to reduce fat on the lower face 2. Factite or Renuvion/J Plasma to tighten the lower face, jawline, and chin to reduce fat and give the jawline and neck tightening and shaping. 3. Botox to the masseter to reduce the muscular size of the jaw giving the face an illusion of being more slender 4. Fillers to the jawline, chin, cheeks, temples and brow help to shape the face and make it more angled and defined Always use at home derma rolling (see link to Emerageskin x anteageMD roller plus stem cells/hyaluronic acid ampules) and peels like emeragecosmetics enlighten or aerify that can be used to improve skin quality and tighten the skin while improving wrinkles, pigmentation, acne, and Melasma. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

Michael A. Persky, MD · Answer

Hi Affectionate,
I would treat you with both, treat your masseter muscle with Botox and treat your face with the biostimulatory injection of Sculptra.  Make sure to choose your treating physician very carefully!  Feel free to contact me with any further questions or concerns.  Good luck and be well.
Dr. Persky
Encino, CA

Stuart Diamond, MD · Answer

Filler can definitely help even out your cheek and jaw area. I would recommend using filler first and then from there you can discuss with your injector about if the masseter treatment would work for you.

Camille Cash, MD · Answer

You will likely have the best result from a combination of the treatments.  Botox and fillers are great tools to address facial asymmetry.  Botox can be used in the masseter muscles to slim the jawline.  Filler can be added to address deeper folds and balance volume of the face.  Visit with an experienced injector near you for treatment.

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