Masseter Botox and jowls - will this improve or do I need to do something? (Photo)

Question

I’ve had Masseter Botox many times but this time a new injector gave me 35 units on both sides that’s given me massive jowls, when I smile I look like a chipmunk. It’s been 3 months. Will this improve or do I need to do something. I’ve never had this before and I hate it.

Anna Chacon, MD, FAAD · Answer

I’m sorry you’re dealing with this — and I want to reassure you that what you’re describing is a recognized complication of masseter Botox, especially when the dose or injection placement differs from what your face has previously tolerated.

The fact that you’ve had multiple prior masseter treatments without this happening is actually an important clue. It suggests that the issue is less likely to be your natural anatomy suddenly changing and more likely related to this particular treatment.

What may have happened?

When Botox weakens the masseter muscle, the lower face can change shape in a few ways:

The masseter shrinks, which is often the desired slimming effect.
If the muscle is weakened too much, too low, or in a slightly different pattern than before, the surrounding soft tissues may lose some of their support.
This can create the appearance of new jowls, heaviness at the jawline, or a “chipmunk” or puffy smile because other muscles of facial expression become relatively more prominent.

At 35 units per side, the dose is not necessarily excessive for everyone, but it may have been higher than your usual dose or injected in a way that affected the lower portion of the masseter more than previous treatments.

The good news: at 3 months, improvement is very possible

Botox in the masseter typically lasts:

3–4 months for noticeable weakening,
sometimes 4–6 months for full recovery of muscle strength and volume.

Because you are 3 months out, you are right around the point where many patients begin to notice gradual improvement. The masseter muscle should slowly regain activity and bulk, which can help restore some support to the lower face and reduce the jowly appearance.

What concerns me less

From your description, this sounds more like soft-tissue sagging related to masseter weakening than a true permanent jowl caused by aging. The sudden onset after a specific injection session strongly supports that interpretation.

What can be done?

In the short term:

Time is often the most important treatment.
Avoid additional masseter Botox until the effect has clearly worn off.
Gentle facial movement and normal chewing are fine; you do not need to avoid using the muscle.

If the heaviness is still significant after 5–6 months, options that are sometimes considered include:

Jawline filler to restore contour,
Skin-tightening treatments (radiofrequency, ultrasound, or RF microneedling),
or very conservative lower-face support treatments if there was already mild laxity before the Botox.

I would not rush into dissolving fillers or having surgical treatment based solely on a 3-month post-Botox result.

Why your smile looks different

The “chipmunk” appearance when smiling can occur when the masseter is weakened but the risorius, buccinator, and other smile muscles are still pulling normally. This imbalance is usually temporary and tends to improve as the Botox effect fades.

My honest impression

Based on your history — many previous successful masseter Botox treatments, a new injector, sudden onset of jowls and a puffy smile, and only 3 months having passed — I would be cautiously optimistic that this will continue to improve over the next 1–3 months as the masseter recovers.

If you had shown me this at 2–4 weeks, I would be even more confident it was purely temporary. At 3 months, I still think recovery is likely, but I would expect the most meaningful improvement to occur between months 4 and 6.

The key point is that this does not sound like a permanent “ruined jawline” situation. It sounds much more consistent with a temporary change in lower-face support and muscle balance from this particular Botox treatment, and in many patients that gradually becomes far less noticeable as the masseter function returns.

Camille Cash, MD · Answer

I'm sorry you are unhappy with your treatment.  The effects of Botox are temporary.  The unwanted effects should gradually improve over three to four months.  There is no reversal agent for Botox.

Masseter Botox and jowls - will this improve or do I need to do something? (Photo)

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