Botox for masseter reduction?

I had my first Botox masseter reduction (25unit each side) done a little over two weeks ago, now without seeing any change on my jawline, I'm experiencing sunken cheeks dramatically caused by this Botox injection (I didn't have any other injections besides Botox and it was done by an Amercia certified plastic surgeon). I wonder if this sunken cheeks will stop and if the Botox effect hasn't reached its peak yet which my cheeks will be sunken in more. Please help!

Doctor Answers 11

Chin/Cheek Augmentation -- Fillers such as Radiesse, Voluma, Perlane/Fat/Implant

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Botox shouldn't cause the cheeks to sink much unless the upper masseter was truly affected.  You would need fillers or fat or sculptra to improve this area.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Botox for masseter muscles

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You should return to your plastic surgeon for assessment.  You may require more Botox if the lower part of the muscle is still strongly active.  Additional Botox can slim this area giving a more pleasing result.  If you do not like the result, it will wear off in about 3 months.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

Properly Injected, Botox Can Work Well For Tapering The Masseter Muscle

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In general, there are two acceptable approaches to injecting Botox for tapering the masseter muscle. One approach requires three injection sites, two along the jawbone portion and one a bit higher and more centrally placed, forming a triangle. A second approach, also at the lower portion of the muscle, is to inject the strongest point found during clenching. Both techniques, as mentioned, are  performed essentially within the confines of the lowest third of the muscle. Performed here, the desired tapering can be achieved.From your description, it seems that perhaps the injections were given too high, which may account for the lack of effect below and the cheek flattening higher up that you describe. While understandably very distressing, the good news is that the affects of  Botox, which usually reach their peak between 7-14 days following treatment, are temporary and will wear off--typically in three to four months. It would seem wise to contact the treating physician to alert him/her to this. Sorry you are having this problem.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

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Botox masseter

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Botox effects usually set in by 10 days so the full effect should be seen by 14 days. If you think your cheeks are too sunken, then you can use a smaller dose next time or focus the injections only at the bottom of the jawline (at the inferior border of the masseter muscle). Your cheeks should go back to normal once the botox effects wear off. Good luck. Best, Dr H 

Sanaz Harirchian, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 26 reviews

Botox for masseter reduction

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Botox is often used to weaken and thin the masseter muscle at the back of the jawline which creates a rounded facial appearance when they contract. At 2 weeks, the Botox should be in full effect and it is unlikely your muscles will atrophy (shrink) much more over the next few months. If you refrain from additional injections in the future, it is expected that your masseter muscle will return to its original size and your sunken areas will be reversed. Hope this helps!
Johnson C. Lee MDPlastic Surgery 

Johnson C. Lee, MD
Beverly Hills Physician
5.0 out of 5 stars 17 reviews

Botox results after masseter injection

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It appears the injector may have misplaced the Botox a little too high along the masseter muscle. This probably results in diffusion of the Botox into muscles not intended which can depress the cheek. Unfortunately it will take time for the Botox to wear off and the cheeks to return to normal. As for masseter reduction and facial slimming, it usually takes up to 6 weeks to see the actually atrophy of the masseter which results in the slimming. At this point, I would followup with your injector to discuss your results. 

Botox and masseter

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The sunken area may be due to incorrect placement of the material and should be complete now. 25 units is very small and you won't get any reduction in the jawline

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 7 reviews

Botox for jawline slimming

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The effect that you see has likely peaked at this point and I don't think your cheeks will sink in more and unfortunately, I don't think your jawline will slim down any more either. If you look at the anatomy of the masseter, it goes from your jaw bone all the way up to the bone on the side of your face by your ear. Botox for jaw slimming is rather subtle and depends on how bulky your muscle is at the jaw bone to begin with. If your goal is merely jawline slimming and you do not want the cheek sinking, talk to your practitioner about this and focusing injections only at the jaw bone. 

Lily Lee, MD
Pasadena Plastic Surgeon
5.0 out of 5 stars 29 reviews

Needs some time

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Time will help this.  Botox is max at about 2 weeks.If you are "too" sunken, then the dose can be lowered next time to achieve a better look.For now, it will take time to improve.

Botox for the masseter

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Thank you for your question mestand1. Botox is a purified protein used to address muscle associated with facial expression. Botox can be placed in the masseter muscle in the lower face to contour the face. This will decrease the bulk of the muscle. Everyone has slight anatomical variation. If the muscle extends high into the cheeks, that area may get smaller as well. The pivotal studies demonstrated that the peak effects of Botox are seen 14 days after a treatment. Please follow up with your doctor for specific recommendations. Good luck!

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.