Bulge and lost volume after masseter Botox - only 29 yo. Please help!

Question

Had my 1st session in Jun 17 + top up 6 weeks later + 2nd round in Nov 17 + a top up in Jan 18. First photo is taken 2 months after my 1st session and 2nd photo is taken this week (i.e. 1 yr) I feel like they've completely ruined my face! My cheeks have dropped + I have developed a strange bulge on each side of my face. The bluge is bigger on the side where more botox was injected (stronger side). There are strange smile lines that are pulling up from my chin. Please help! :(

Jason Emer, MD · Answer

After the Botox resolves, your face should revert back to its normal state. Venus legacy may soften results. Best, Dr. Emer

Jayanthy Ravindran, MS, DNB, MRCS · Answer

Hey there,Masseter botox injections when misplaced anteriorly or when it migrates anteriorly can weaken the smile muscle risorius and can cause these effects. Overcorrection also is a possibility in your case causing drooping. But anyway, these botox effects will slowly fade and return back to normal in 3-4 months’ time. 
Hope this helps.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs justheretolook2. 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.In the mid face, the zygomaticus muscles sit near the masseter muscle which is treated for TMJ pain or to contour the lower face. The masseter muscle is used to bite down when eating while the zygomaticus muscles pull the corners of the mouth upward when smiling. If Botox spreads from the masseter muscle to the zygomaticus muscles and relaxes these muscles it can lead to the appearance of an asymmetric smile. This side effect resolves on its own in 2 weeks to 4 months, depending on the severity.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 as described above. 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!

Richard Brighton-Knight, MBChB · Answer

The best thing to do is to let the Botox wear off and then review what the lines look like. There may be other reasons for changes in your face the aren't due to the Botox, if you've got a low body fat your face is more susceptible to an changes in the deeper fat layers for example.
Changes in due to Botox are likely to wear off over time, which means that if it due to the Botox it will wear off.

Leonard Grossman, MD · Answer

For starters, your face is not ruined, but I do understand your concerns because they are serious ones. Let the Botox wear off and then see somebody who is much more proficient in the use of Botox for the masseter muscle or don't use anything at all. Good luck for New York City

Bulge and lost volume after masseter Botox - only 29 yo. Please help!

Answers (5)

Answer: Let the Botox wear off.

Answer: Let the Botox wear off.

Answer: Botox trouble

Answer: Botox trouble

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Bulge and lost volume after masseter Botox - only 29 yo. Please help!

Answers (5)

Answer: Let the Botox wear off.

Answer: Let the Botox wear off.

Answer: Botox trouble

Answer: Botox trouble

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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.