Volume loss in cheek after Botox on masseter (Photo)

Question

Had Botox on tha masseters and only one side took which was my left side. Unfortunately, I have volume loss on the left cheek around the nasal labial fold and now the smile line is longer passed my mouth and deeper. It’s been almost a year and it has not changed. I believe this is permanent. Is it deteriorated muscle tissue or is it fat loss? I need to know what procedure will rectify this. Sorry photo is upside down

Fady A. Sinno, MD · Answer

It is hard to evaluate from one picture, but I definitely see your asymmetry. Your volume loss is on your RIGHT upper cheek (unless the picture is a reversed, mirror image). Your opposite nasolabial fold is deeper. I do NOT believe Botox to the masseter had anything to do with this. Neurotoxins to the masseter are quite effective, and can result in (desirable) atrophy of the muscle, but not to the soft tissues of the upper face. By the way, your masseter areas look fine in this picture.
Your volume loss and asymmetries can be easily treated with a number of available fillers that are safe and effective. We are now fortunate to have a very wide assortment of excellent fillers, with different properties. Some are placed deep (over the bone), and other can be injected very superficially in the skin. Many of the customized treatments would include more than one filler, that are "layered " for specific purposes. You should consult with an ABPS certified plastic surgeon who can give you treatment options after a thorough examination. Best wishes!

Charles S. Lee, MD, FACS · Answer

This does occur on occasion but if you wait long enough, the volume will usually return. I would use fillers in the hollow area for now.

Alexander Rivkin, MD · Answer

Hello and thank you for your question.  When injecting the masseters, your injector need to be extra careful in not getting into surrounding muscles that contribute to your smile.  Unfortunately there is no reversal agent for Botox and you must wait out the effects (usually 3 months).  You may see some improvement in a few weeks or so as the Botox does tend to let-up a bit.  Moreover, treating the masseters to slim down the jaw line can take up to a few sessions.  The goal is to reduce the muscle's strength with the help of Botox. Since the muscle is not being used to its full potential, it will shrink down over time (usually 6-9 months) and give the face a more oval appearance.For your next treatment, make sure to see an injector with plenty of experience treating the masseter muscles. Best of luck!

Jonathan Kulbersh, MD · Answer

Botox will not cause volume loss or fat atrophy. Also, Botox results resolve in 3-4 months. Fillers or implants are good choices for improving facial volume. Hope this helps.

Eric M. Joseph, MD · Answer

We have not seen any cases of volume loss or fat atrophy after Botox treatments for masseter enlargement. Consider re-asking your question with both before and after photos for the best advice. Wishing you well. Dr Joseph

Jason Emer, MD · Answer

It's unlikely that Botox caused this volume loss. Volume and symmetry of the face created with well-placed fillers (Voluma, Radiesse, Bellafill) and Sculptra. Implants or fat are alternatives. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Monika Soni, MD · Answer

We have not seen any cases of volume loss or fat atrophy after Botox treatments for masseter enlargement. Consider re-asking your question with both before and after photos for the best advice.

Michelle Ellern, DO · Answer

I would either follow up with original injector or with a new consult. However, you need to have photos from prior to the injection and now to determine the true effect of the botox vs what was already present prior.  Botox slims the face by decreasing the bulk of the muscle in that area and doesn't affect fat.  Good luck with your treatment consult.

Michael H. Gold, MD · Answer

Thanks for your question and sorry that you are having this is concern. We always recommend that you have these procedures in the offices of board certified dermatologists or plastic surgeons as know the most about injections and care in this area. You most likely have volume loss and need to have some HA filler injected – again this will be determined at the time of your consultation.  Usually, more than one injection is needed into the masseters for reduction – and again, from the photo there looks like there is volume loss there.

Marek Kacki, MD · Answer

It is impossible to judge when only one photo is available. You need to find your photo done before your first dose of Botox, a photo with identical or very similar facial expressions and the same light direction. Only then you can see the dynamics of the changes. The volume of the master can be decreased with repeated injections of Botox, however, the overall change would not affect the cheek volume that is made of fat compartments. Any asymmetry can be corrected if it is really necessary. We all have certain degree of facial asymmetry that, quite often, becomes am issue only after we accidentally notice it or is pointed to us by others. So, reassess your changes based on the recent and previous photos and if you feel you want any existing asymmetry to be corrected, discussed it with your injector. Good luck!

Volume loss in cheek after Botox on masseter (Photo)

Answers (13)

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