I got Botox injected into my masseter muscles about 5 days ago and I believe it has made my masseter muscles even bigger.

Question

The doctor did one injection on each side and I am unsure of the amount. However, now, when I clench my teeth, the masseter muscles protrude out even more than they did before the botox. I'm very confused, I don't have any pain and am not sure if this is swelling because I can only see the enlargement when I clench. Thanks in advance for any help!

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox or Dysport can be a very effective way to contour the jaw line by reducing the masseter shadow through the outer jaw skin.  In addition, it can reduce symptoms of jaw clenching or grinding of teeth at night time.  This is an advanced technique that requires a strong understanding of the underlying anatomy.  Some side effects can results in some very unintented effects.  This can include affecting the smile due to diffusion of the Botox into neighboring smile muscles.  Over treatment can also overweaken your jaw muscles making it harder to chew food and causes your jaw muscles to relax too much when you sleep.The injection technique does vary by physical exam and the goals of the treatment.  Facial contouring goals may change the injection sites themselves to affect different portions of the masseter as well as the dose. The strength of the masseters can be felt by palpation and also helps me to determine dosing.  In general, I start with 15- 25 units of Botox (OR 50-75 units of Dysport) per side for most patients.  If they have very strong masseters, then I may increase the dose, but more commonly ask them to return in three weeks for a touch up. If you notice one area bulge after the procedure, then a small dose may be required to quiet that portion of muscle. Once you get the desired result, I let patients know that future treatments may require less to maintain the look or the jaw clenching symptoms, especially if they get treated as soon as they notice the symptoms return.  This can be as soon as three to four months, but in some cases, patients report that it lasts six months or more.  I find it depends on the dose we use and how many times we have done the procedure as the duration may lengthen for patients that repeat it regularly.

Martin Jugenburg, MD · Answer

Typically there are 3 injections administered to treat the masseter muscle. Speak with your injecting physician to discuss your results or obtain a second opinion. Best,

Charles S. Lee, MD, FACS · Answer

This happens on occasion and is easily remediable by returning to your injecting doctor and have him/her place 5U into the bulge. It may resolve on its own but generally I have my own patients return for this. We have been performing this since 1999 and have the largest reported series at the time we first introduced the technique to North America.

Harold J. Kaplan, MD · Answer

Treating this large muscle can be very rewarding aesthetically as well as clinically.  Most practitioners will use a 4-5 injection sites per muscle in a dice-like pattern directly into the bulging portion of the muscle.  Having only one injection site can limit the full effects of your treatment as well as lead to more muscle tenderness and swelling by placing all the solution/product into one injection site. We recommend following up with your injector for an assessment.  Although the benefits of treating this area is slow and progressive, your practitioner will be able to determine if there are any causes for concern and how to monitor your outcomes.  The link below will offer more feedback as well as before and after photos of our jaw reduction patients in Los Angeles and Orange County.

Michael A. Zadeh, MD, FACS · Answer

Botox can take up to 2 weeks to see its effects. The masseter is a large muscle, so depending on how many units you got in the first session, you may require more to achieve your desired effect. The enlargement you are describing may be related to swelling or some bleeding with hematoma formation in the deep tissues. You should schedule a follow up appointment with your injector to have your concerns addressed. Good luck to you.

Jason Emer, MD · Answer

It takes up to two weeks for the muscles to atrophy, I would give sometime to calm down.  If you have swelling or pain, tylenol and cold compresses help.  Best, Dr. Emer

Mabrie Facial Institute | San Francisco · Answer

Thank you for your question! Although the effects of Botox can begin to kick in around day 3-5, it takes a full 2 weeks for Botox to reach full effect. However, the slimming effects can take up to 30 days to see, as the muscles requires time to atrophy (decrease in size). It is likely that you are having some swelling from the injections. I recommend using a cold compress and over the counter analgesics for any discomfort or swelling. After two weeks if you don't see improvement I advise returning to your injector. 
I've created a video that reviews treating the masseter muscles with Botox/Dysport. I hope you find this helpful with your research!

Alex Eshaghian, MD, PhD · Answer

Thank you for your question chubsface44. 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 in the absence of consistent photographs before and after in the same lighting and angles for comparison. 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.
To determine if someone is a good candidate for this treatment it is necessary to look at a person’s lower face when biting and comparing it to when the person is not biting. If a bulge is seen on the outer portion of the jawline, then the person is likely a candidate. It can also be felt with the fingers when biting.
The pivotal studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.If I had a patient with the concern described I would recommend waiting a full two weeks and at that time returning to her provider for photographs to assess the results.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. 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!

Steven F. Weiner, MD · Answer

I haven't heard of just one injection for the masseter injection. It is obvious to me that you were not properly treated and need more Botox injected. This should resolve the problem.

Martie Gidon, MD, FRCPC, FAAD · Answer

It can take up to two weeks to see the full result from your Botox treatment.  One injection site may not be enough if you have well-developed masseter muscles.  Comparison with previous photos would help.  The swelling may be bruising but please return to your physician for assessment.

I got Botox injected into my masseter muscles about 5 days ago and I believe it has made my masseter muscles even bigger.

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