Smile lines after masseter Botox (Photo)

Question

I’m 18 years old and got 50 units of botox in my jaw for clenching and grinding at night. A couple months in I started noticing smile lines developing and getting deeper. Is this because of the amount of volume I lost in my face? Because I’m still so young will collagen in my body be able to deal with them? And also will they go away once the botox wears off?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and your concerns. What you are noticing can happen after masseter Botox, especially when a relatively high dose is used in someone young with naturally lean facial features.

When the masseter muscle shrinks in size, it can make the midface appear a bit slimmer. For some people, this results in changes such as smile lines (nasolabial folds) or hollowing becoming more noticeable. This doesn’t mean you’ve lost “true” facial volume—it’s more of a change in muscle bulk and balance in how the soft tissues are supported.

Because you are 18, your skin is still rich in collagen and elasticity. This is in your favor, as your body is better at adapting to changes compared to someone older. Once the Botox wears off and your masseters regain some of their natural size and function, the folds should soften again. The changes are not permanent, and your collagen alone is unlikely to be permanently “used up” or depleted at this stage.

If the lines remain bothersome, there are supportive treatments that can help, such as subtle dermal fillers or skin-boosting treatments that improve elasticity, but in your case, time and patience may be all that’s needed.

Yes, the lines are likely related to the reduction in masseter bulk. They should improve as the Botox effect wears off, and your youthful collagen and elasticity will help restore balance.

David Yew, MD · Answer

Getting Botox for TMJ to relieve clenching and grinding is important for your quality of life.   Whether you get Botox for this - you will still have nasolabial lines that are mostly from dynamic expression.  Every time you smile - you are creasing the folds and making them deeper.  Losing volume can also contribute to these lines - but at your age and with one botox treatment - it shouldn't be an issue.   See the attached link to understand Botox for TMJ better.

Smile lines after masseter Botox (Photo)

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