25 units of Botox injected in each masseter muscle but see no difference. Do I need more?

I had 25 units of botox injected to each masseter muscle last year, but never saw any significant difference. It did shrink slightly, but not by enough. Do I need to get more injected this time?

Doctor Answers 18


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Botox is injected into the masseter muscle (which is the muscle along the jawline and in front of the ear) for 2 general reasons: to alleviate the pain of TMJ Disorder and/or headaches associated with TMJ and, second, to round out an overly square face.  The # of units depends on the muscle bulk and the reason you are having the injections.  25 units of Botox per side is a generous dosage. If after two weeks, you are either still feeling pain in the TMJ, or, if you want less bulk from a cosmetic vantage, then you may need more. I will tell you that when injecting Botox for TMJ, it is important not to take a Cookie Cutter approach and inject everyone the same way.  The physician needs to carefully examine the patient and asked to make movements, clench, bite, etc. so that he can pinpoint the injection points. Otherwise there is no point. The good news is that this is not a problem without a solution. Be well. 

25 units of Botox injected in each masseter muscle but see no difference = one treatment not enough = several required #Botox

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Botox can be used to decrease the bulk of the masseter muscle and therefore narrow the lower face around the corner of the mandible . In order to do that the muscle hast to shrink (become atrophic)  dude to decrease activity secondary to Botox treatment. This doesn't happen overnight. Therefore, in order to see the effect of Botox in masseter: 1) time has to pass and 2) very likely several serial treatments of Botox might be necessary 

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 136 reviews

Botox for masseter reduction

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Botox for masseter reduction is very effective at reducing the bulk of the masseter muscle and thereby slimming the jawline.  25 units per side is a very typical dose to relax an average sized masseter muscle.  If your muscle did not move and remained soft even with clenching, then it was an adequate dose.  If there was still significant muscle movement, then a slightly higher dosage of Botox would be more effective at creating slimming.In addition, serial treatments - every 4-6 months, will accentuate the slimming effect by continuing to shrink the muscle.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Masseters and Botox

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I typically start with 25 units per side for the masseter muscle.  On the followup visit, the patient says whether it was adequate and if it wasn't I will typically go up.  I've gone to 40 units per side for an occasional patient.

Marla M. Klein, MD
Lake Oswego Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Masseter Injections

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Thank you for your question.

It appears that you may require a larger dose. I'd recommend speaking with your qualified injector to discuss your concerns and to determine your options.

All the best.

#Masseter Reduction with Botox

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Dear Likelotus:

An intelligent answer to your question would require a more extensive history and an examination. I would want to know if you grind your teeth, have TMJ problems with headaches,  or are they looking to make a squarish face more oval. After the treatment, I would want to discover if you are still able to clinch your masseter muscles, and if there are any areas of the muscles where you don't have a full affect.

With this treatment, the size of the masseter muscles reduces more with each treatment that you have, especially if you do not let full function return before the next treatment. It's like having a cast on your arm – – if you have ever had this you may recall that the muscle get smaller when it's not used. Similarly, the masseter muscle needs to remain at rest, or at least not clench as much as it did before for a period of months before it will reduce in size.

So depending upon your history and examination, you may not need a larger dose you may just need to have it done more frequently.

All the best,
Dr. Clark

Botox in masseter

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Patients seem to think that after a single treatment with botox in the masseter that it will shrink in size.  It requires multiple consistent treatment every 4 months or so. It does not occur after just one treatment.

Botox for masseter muscle

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Botox can be a great option for decreasing the size of the masseter muscle and in patients who grind their teeth.  Generally, dosages range from 20-40 units per side.  It is important to know that the best results from treatment of this muscle will take time unlike treating movement lines.   Over time, due to muscle inactivity, the muscle will shrink with a peak at 4-6 months; repeated treatments are usually necessary to further improvement.

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

Masseter Botox treatment

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25 units should give some improvement. If you didn't notice much, consider a different injector. I start with 15 per side and go up to 40 per side. To see real atrophy of muscle, multiple treatments are needed. See link.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.8 out of 5 stars 53 reviews

Botox injection in the masseter

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Botox jaw reduction is a specialized technique to reduce the width of the jawline changing an overly square jawline to a more attractive oval or heart shaped face.In some patients, the the masseter muscle, a chewing muscle, is enlarged creating extra facial width. Botox selectively weakens this muscle over time leading to an overall reduction in the size of this muscle.

Some personal habits can be directly attributed to your enlarged jaw muscles (the masseter). Excessive gum chewing, chewing hard items like ice or tougher meats, all can lead to an enlarged masseter muscle. Stress can lead to bruxism (grinding your teeth at night) which can enlarge your masseter as well.

25 units is quite genrous.  However several treatments may be necessary to see improvements.

Sarat Sabharwal, MD
Altamonte Springs Urologist

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.