Masseter Botox or buccal fat removal? (photos)

I am a tall thin mother of two children, and I will be turning thirty soon. I noticed sometime after 25 I started to dislike my face in photographs. The lower third of my face started to appear more square or like an upside down triangle. Would masseter Botox or buccal fat removal be beneficial? Or is this premature sagging/aging? Any ideas?

Doctor Answers 15

Masseter Botox or buccal fat removal?

Thanks for your question. Based on your photographs, you could probably benefit from masseter injections to decrease the volume of your masseter muscle along your jawline. At the same time, I would recommend some filler to restore the youthful triangle by augmenting the cheek areas with something like Voluma or Restylane Lyft. Buccal fat removal would not correct your problem, and I feel it's a procedure that can leave you with more problems afterwards. I hope this helps...good luck!

New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 47 reviews

Botox to masseter

The massester muscle helps us chew and it is located at the lower sides of the cheek.  you can feel this muscle by gently placing a hand on your lower cheek and clenching your teeth.  often times this muscle can contribute to a square appearance to the jawline and Botox can help to relax this.  The result is a subtle and natural appearance of narrowing the jawline.  Based on your photos, you appear that you would be a very good candidate for this treatment.  However, a final decision would require an office visit and evaluation.  Best Regards!

Sean R. Weiss, MD, FACS
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Square Jawline

Neuromodulators such as Xeomin or Botox are a great, temporary way to see if reduction in your jawline is what you are after.  The chewing muscles on the sides of your face would be weakened causing a narrowing of the lower face.  This is a popular treatment for cosmetic purposes as well as for bruxism (grinding teeth).  I would rarely recommend buccal fat removal unless a person has very fatty cheeks.  That area of fat diminishes with age and removal of the buccal pad can increase the gaunt look in a thin person.  Your best bet is to schedule a consultation to explore your options. Hope this is helpful.

Marilyn Pelias, MD
New Orleans General Surgeon
4.7 out of 5 stars 14 reviews

Botox for masseter reduction for jawline slimming

Based on your photos, it does appear that your jawline appearance could be improved and tapered with Botox for masseter reduction.  It will reduce the bulkiness along the angles of your mandible (where it is starting to look square).  In person examination would be best to determine your candidacy for this procedure, as the size of the masseter muscle needs to be evaluated.

Although buccal fat excision is an extremely effective surgery in the properly selected patient, you should not pursue buccal fat excision as it will make you appear prematurely aged and hollow.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

Masseter Botox or buccal fat removal?

  Hi, IMHO and with over 30 years of experience in facial plastic surgery, neither of those two options will make your face more feminine and naturally attractive.  Buccal fat removal is a 15 year old procedure that should be avoided as it creates hollows below the cheeks.  Your Masseter muscles are not too large (Botox isn't need to reduce these) but rather your face shows the signs of aging that neither Botox nor Buccal fat removal will address.

 From the attached photos, the cheeks are flat anteriorly (in the front), there is excess facial and neck fat along with excess facial skin evidenced by jowls and nasolabial folds.  These combine to create a rectangular shaped face.

  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation using a dermal filler (I prefer Restylane Lyft) or with cheek implants for a permanent enhancement will create full, round cheeks anteriorly that will feminize the entire face.

 Jowls are sagging facial tissues and an indication for some form of a facelift.   The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured.  The excess skin is then removed and the facelift incisions closed.

 My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane and subperiosteal facelifts) but with these added benefits:

•very small incisions
•minimal tissue dissection = less bruising and swelling = rapid recovery
•can be performed in 90 minutes or less, with or without anesthesia
•no incisions within the hair = no hair loss
•excess fat can be removed
•excess skin removed
•cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
•most patients fly back home to parts all over the world in as little as 3 days post-op

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Masseter Injections


Thank you for your question.

Based on your goals, you may want to consider masseter injections. 

I recommend you book a consultation with a qualified injector, to ensure you're a good candidate for this procedure. 

Take care.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

OK to start small

Small injections of Botox into the lower masseter will reduce the muscle bulging and you can judge how you like the results in your face.  The buccal fat pad will not change with the masseter reduction, so you can judge for yourself the result.
Other procedures such as Juvederm Voluma into your cheeks can minimize the upside down triangle.

Keith Denkler, MD
Marin Plastic Surgeon
5.0 out of 5 stars 18 reviews

Masseter Botox or Buccal Fat Removal

Thank you for posting your photos with your questions. My approach to your natural facial rejuvenation would be to restore the lost volume and contour of your cheeks and chin. Looking at your photos, you have a youthful neck and jawline, but have lost some volume in your cheeks. At the time of your consultation, I would like you to bring a photograph of yourself from 5 years ago for comparison. Together we would analyze the subtle facial changes and I would come up with a treatment plan. Most of the volume lost in the face, between the ages of 25- 55 years old is due to bone loss! This lost volume results in the face sagging in predictable patterns. For immediate results, you could use fillers that are designed to lift and resist the compression of the cheeks and last several months and up to 1 year. These are considered high G' fillers like Radiesse, Voluma, and Restylane Lyft. For longer lasting natural results, I would suggest Sculptra Aesthetic, which is a facial volumizer, that restores the natural facial volume and contour for up to 2 years. However, Sculptra Aesthetic works by stimulating your body to produce it's own natural collagen and this takes between 4-6 weeks. BOTOX or Dysport, injections to the masseter muscles will give your lower face a more triangular appearance.  Removing your buccal fat pads will make your cheeks look hollow and I would not recommend this surgical procedure in you. Most importantly, I recommend that you have a consultation with a Board Certified Plastic Surgeon who is experienced with facial rejuvination with fillers and BOTOX and can answer your questions, listen to your goals and show you before and after results, before you proceed. Best wishes, Dr. Richard Swift

Richard Wellington Swift, MD
New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Masculine Facial Structure, How to Improve it?

I suggest the right amount of fillers on the jawline, botox for the masseter  and neck and even some skin tightening of the neck/jaw like thermage, ultherapy or thermiRF/VASER lipo you could reshape your jaw/face and give you the more "heart shape" and less prominent masculine jaw you are looking for.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 191 reviews

Masseter muscle reduction with Botox - Williamsville, NY

Thank you for your question and pictures.

The pictures you provide indeed suggest that you have prominent masseter muscles and expert, repeated masseter muscle injection with Botox should get them to atrophy or 'reduce' in size. 

Dr. Karamanoukian

Hratch Karamanoukian, MD, FACS
Buffalo Phlebologist
4.8 out of 5 stars 41 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.