Does masseter Botox have permanent effects?

Question

I got masseter botox 8 months ago and it completely narrowed my round face to an egg/oval shape, and I pretty much lost all volume in my face. I didn't have strong masseters in the first place, they were very weak. To this day , it is still the same and there hasn't been any sign of improvement. I've been chewing everyday and although it feels stronger, the muscle doesn't look like it got any bigger. Did I get too much as a first timer? (35 units, 15 on one side and 20 on the other).

Anna Chacon, MD, FAAD · Answer

Hello, and thank you for your question. Masseter Botox is commonly used to slim the jawline by reducing the size of the masseter muscles, but its effects are generally temporary, lasting about 3 to 6 months. However, some factors can influence the duration and extent of the effects:

Dosage and Muscle Size: The amount of Botox you received (35 units in total) can significantly impact the results, especially if your masseters were not very strong to begin with. Over time, repeated treatments can lead to muscle atrophy, which may result in a longer-lasting effect.

Individual Variation: Each person’s response to Botox can vary. Some individuals may experience prolonged effects due to differences in muscle activity, metabolism, and other physiological factors.

Muscle Activity: Even though you have been chewing daily, it might take more time for the muscle to regain its previous size and strength, especially if the initial Botox treatment caused significant atrophy.

Given that it has been 8 months without noticeable improvement, it might be beneficial to consult with your treating physician or a board-certified dermatologist. They can assess your current condition and provide personalized advice on potential next steps, which might include allowing more time for natural muscle recovery or exploring other treatments to restore facial volume.

Warm regards,

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Masseter Botox typically provides temporary results, lasting around three to six months, but in some cases, the effects can last longer, especially if the muscle has been consistently weakened. However, Botox itself does not cause permanent muscle atrophy; rather, it temporarily inhibits muscle activity. If your face hasn’t returned to its previous appearance after eight months, it might be due to factors other than just the effects of Botox. Chewing may help engage the masseter muscles, but if they were weak to begin with, it might take time to regain volume and strength. It's also important to consider that overall facial volume can be affected by other factors, including age, weight changes, and skin elasticity. I hope this helps and best of luck!

David Yew, MD · Answer

The botox has worn off and the muscles will start to get stronger and get back to it's original size over the next few months.   It's important that your provider took a weight at your treatment so they can compare what your weight is now.   People usually fluctuate in weight so it makes a difference if you lost weight.   Please watch the supporting link to understand how Botox works for facial slimming.

Eric M. Joseph, MD · Answer

I'm not certain why you are experiencing persistent effects of Botox 8 months after your procedure. If your doctor took pre-injection photographs, it may be helpful to review them with him or her on a follow-up visit. Thank you for your question. Sincerely, Dr Joseph

Michael A. Persky, MD · Answer

Hello there Viv,
Not to worry, the Botox that you recieved 8 months ago for your masseters was a normal to low dose, it has worn off by now.  I would closely examine your before photos with todays photos, if there is a marked difference then something else may be going on.  Are you taking Ozempic?  There are great treatments to restore your round face if your concerns persist.  Good luck and be well.
Michael Persky, MD
Encino, CA

Camille Cash, MD · Answer

The effects of Botox are temporary, generally lasting three to four months.  The dose that you received is within a normal dosing range. Once the Botox is gone your muscle will slowly return to their pre treatment state. To understand the changes you experienced it's important to understand how neuromodulators like Botox work.  I've included a video that I hope you find helpful.

Jacquelline Leva, DO · Answer

Botox on average only last 2-3 months rarely with continuous use 6 months...so it is unlikely to be the botox. Weight loss Can also possibly make you have less round face.

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