Is this normal for masseter Botox? Jaw seems bigger (Photo)

You need an in-person examination, but I don't think that's your bone. It's likely part of the masseter muscle which requires more Botox. I would recommend following up with your injecting physician. Best wishes.

it looks like your masseter is bulging outward. You need a small amount of botox injected to the remnant muscle that is still active when you bite. It may correct itself, but if it continues more than a couple of weeks, I would have the injector reevaluate for possible small number of additional units injected into the muscle.

It would be best to consult with the doctor who did the injection to make sure your injection is having the desired effect, and an asymmetry in muscle strength is not causing your problem.

Botox results last up to 3-4 months and can be softened with venus legacy and thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hi Selena 90, thank you for your question and photographs.  I would advise you to return to your injector, you likely need a few more units on that side.  However, an in-person assessment is necessary to determine what the specific cause is, especially if you got the same number of units in both sides.  

Thank you for your question and for sharing your photographs Selena90. 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 and without knowing the dose used and the exact placement of the product. 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.
A phenomenon seen with Botox is called muscle recruitment and compensation. When a muscle has been relaxed with Botox, sometimes other muscles or a different part of the same muscle are recruited and contract when one attempts to make the facial expression. This serves to compensate for the inability of the primary muscle to contract. Sometimes a bulge can appear in a muscle that was untreated or a part of a muscle that was not treated. A common example is the bunny lines (caused by contraction of the nasalis muscle) that are seen on the sides of the upper nose after treatment with Botox in the glabella or for the crow's feet. Since the muscles in the treated area are relaxed, the nasalis muscle contracts in an attempt to compensate for this loss when one frowns or smiles. In such a situation, the bunny lines can be treated with a small amount of Botox (2-4 units per side). In the upper face, sometimes a portion of the frontalis muscle in the upper forehead which was previously not active becomes active once the muscle is relaxed with Botox. In these case, new wrinkles may be seen, often near the hairline. This can be treated with a small dose of Botox in that area. This can also be seen in the lower face when not enough product has been used in an area such as the chin. Sometimes another part of the muscle begins to contract in order to compensate for the relaxation of the muscle from Botox. This can also be treated with a small dose of Botox in that area. Compensatory recruitment can also occur when the platysma muscle in the neck contracts after muscles in the lower face have been relaxed with Botox. Similarly, this muscle can be relaxed with Botox as well. For my patients, I usually use approximately 10 units per band. If placed properly it does not affect other muscles. Relaxing the platysma muscle may also lead to an improvement of jowls and jawline definition. When such recruitment occurs, I recommend prophylactic (preventive) treatment of the recruited muscles at the next treatment.
If I had a patient with the concern described here I would say that first the bulge seen in the pictures is from the muscle, not bone. This is because it is only seen when the patient is clenching (contracting the muscle). Second, I would say it is likely some degree of compensatory recruitment as described above. The dose used was not stated and the placement of the product was not indicated. I would say this could be corrected by placing additional units in the area where the muscle is still active (where the bulge is seen).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!

An average dose of 20 units per masseter should produce the desired effect.  Was the same dosage placed in both the left and right muscles?  From the picture, you appear to continue to have significant muscle activity a week after the injection.  And yes, that is indeed your masseter muscle and not bone.
Followup with the treating doctor to see if the desired result has been achieved.  Based on the photos, you may need more botox in the superficial masseter (the protruding part).  A relatively softer diet for a few weeks to prevent unnecessary damage to your teeth would be a good idea too.  Either way the resulting "bite" is temporary.   

Thanks for your question.  I would go and talk to your physician injector about this problem. My impression is that there is a portion of the masseter that may need additional treatment to prevent it from "bulging" when you clench your teeth. At any rate, the effect will eventually wear off so there is no concern for this being a permanent problem. Best of luck to you!

Thank you for the photos and questions. Your concerns are valid however, Botox is temporary. I would encourage you to return to your injector for reassurance.  Best wishes

Causing weakness of the masseter could allow a shift in the bite but rest assured it is temporary and will go away on its own. however, never hesitate to go back and see your doctor with questions