How to Minimize Rectangular/square Face or Strong Jaw Bone?

Question

Hi I have a very strong jaw bone, they make my face look square/rectangle. They are so strong that it makes me look hollow in the cheek. are there ways I could minimize these strong jaw? And make my face shape more like heart shape instead of square? I have an angular face with very strong jaw bone. I have heard that botox can minimize this. Does disport work the same? Or are there other better treatments? I have also heard that message that area to clear the lymph nodes would help? Thank you !

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox or Dysport can be a very effective 
way to contour the jaw line by reducing the masseter shadow through the 
outer jaw skin.  In addition, it can reduce symptoms of jaw clenching or
 grinding of teeth at night time.  This is an advanced technique that 
requires a strong understanding of the underlying anatomy.  Some side 
effects can results in some very unintented effects.  This can include 
affecting the smile due to diffusion of the Botox into neighboring smile
 muscles.  Over treatment can also overweaken your jaw muscles making it
 harder to chew food and causes your jaw muscles to relax too much when 
you sleep.The injection technique does vary by physical exam and
 the goals of the treatment.  I ask my patients to place their hands 
along the sides of their face over their masseter muscles and clench 
on/off so they can feel the masseter muscles bouncing against their 
hands.  I also ask them to repeat this at home in a couple weeks time to
 compare so they can see the effects of the masseter reduction.  This also allows them to distinguish whether the square face is due to the jaw bone or also the masseter muscles. 
Facial contouring goals may change the injection sites themselves to 
affect different portions of the masseter as well as the dose. The 
strength of the masseters can be felt by palpation and also helps me to 
determine dosing.  In general, I start with 15- 25 units of Botox (OR 
50-75 units of Dysport) per side for most patients.  If they have very 
strong masseters, then I may increase the dose, but more commonly ask 
them to return in three weeks for a touch up.  Once you get the desired 
result, I let patients know that future treatments may require less to 
maintain the look or the jaw clenching symptoms, especially if they get 
treated as soon as they notice the symptoms return.  This can be as soon
 as three to four months, but in some cases, patients report that it 
lasts six months or more.  I find it depends on the dose we use and how 
many times we have done the procedure as the duration may lengthen for 
patients that repeat it regularly.

Jerome Edelstein, MD · Answer

Botox is injected directly into the jaw muscle, known as the masseter,  to relax it, softening your jawline and giving you a thinner appearance.  However, this is only effective if your jaw is affected by prominent masseter muscles. If the aesthetic concern is caused by the actual bone, then Botox will not help. Please see an experienced and certified medical injector for a physical examination to obtain a better assessment of your concern.

Houtan Chaboki, MD · Answer

Yes, plastic surgeons have used Botox and Dysport to help slim the face. While commonly used to reduce wrinkles, Botox and similar treatments can also help reduce excess facial volume. Results gradually develop over several weeks, so don't expect immediate results. Other patients may require surgery to remove fat or bone. Only after a comprehensive evaluation can a plastic surgeon help determine appropriate options for you. Best of luck.

	Dr. Chabnoki

Michael A. Zadeh, MD, FACS · Answer

Botox can work well for some people when the rectangular jaw appearance is due to enlargement of the muscles. By relaxing the muscles, you can give the jawline a softer, more naturally curved appearance. When the loss of the natural jawline is because of volume loss along with the effects of gravity, then fillers such as juvederm or ultherapy can be a good treatment for this.

Sheryl D. Clark, MD, FAAD · Answer

I have used Botox many times to treat an overly prominent jawline in women. It is not uncommon in Asian faces for the face to be more square in shape, and many women prefer, as you say, a more heart-shaped face.  One can inject the same muscles as well as the muscles of the temples in patients who grind their teeth. These patients can have severe chronic headaches and a painful jaw, as well as problems with their teeth. The muscles of their jaw and temples enlarge.  Some don't respond to teeth guards. Botox helps them to relax the involved muscles a bit so that their symptoms are relieved.Dysport should have a similar effect.

Jhonny Salomon, MD · Answer

the best treatment to replace volume loss will be a filler like Radiesse, fat grafting or even facial implants.

Steven F. Weiner, MD · Answer

Women that have large masseters, either genetically (asians frequently) or from bruxism, can make them smaller by injecting Botox or Dysport.  This can take up to 40 units per side of Botox.  I have seen very real changes from this injection.  This is the best treatment for this problem and I would not massage the area or try anything else.  The result is a slimmer lower face and a larger upper face (upside down egg).

Francis R. Palmer, III, MD (retired) · Answer

This is only an issue in a female face, since male faces appear more attractive with increased angularity. In a female face, a string chin/jawline must be compensated with full, round and aesthetically shaped cheeks as this is the beauty "trigger" in the face. Before using Botox to decrease the Masseter, try cheek augmentation with a filler (I prefer per lane) or cheek implants.

How to Minimize Rectangular/square Face or Strong Jaw Bone?

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