Masseter reduction with Botox causes bone loss?

I have been getting 2xYear Botox injections in my masseters to stop night bruxism and daytime clenching, as well as to debulk the masseters which had grown very large and thick. This is the fifth year that I've continued the treatments. Read this recent research and another study using rabbits, which seem to indicate that the mandible is weakened by the injections. Should those of us using Botox in the masseter be worried?

Doctor Answers 10

Masseter and Botox

I would not be concerned for a number of reasons. There was very limited research that has not been confirmed and you are not a rabbit


Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Reduction of mandible bone after masseter Botox

Theoreticaly it is possible and long term paralysis and atrophy of muscle will lead to loss of underlying bone bulk as we see this in extremity paralysis but I am not certain how practical or real this problem is. Only time will tell. You are getting the treatment for a medical problem (bruxism), which may become a bigger real problem if you stopped.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Botox for masseters

I wouldn't we worried. I have injected many patients with Botox for masseters and get the injections myself. I have never seen any convincing data to suggest that the injections results in bone loss. 

Asian population

Botox for jaw reduction is very common in Asia especially in S. Korea.    I have not seen any researching coming out of Korea yet of this side effect on S. Korean women and men getting these injections for years.   I have done this on my patients and on myself, and I do not see any concerns or worries at this time. 

Erik Suh, MD
Bellevue Family Physician
5.0 out of 5 stars 5 reviews

Masseter msucle botox

I have not seen bone loss in my patients after using botox for masseter reduction. Best of luck......

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Botox and Bone Loss

While I understand your concern, I don't think you need to worry about bone loss with Botox. These studies don't point to bone loss in humans. If you're worried, consult your Dr. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Bone resorption

The masseter is the strongest muscle in the human body. Botox injections will cause the muscle to atrophy however not to the degree in which it could effect underlying bone. This, alongside no documented evidence to suggest this could occur in humans is reassuring to say the least. 

Botox and Mandible for Facial Slimming NYC

I perform a great deal of Botox especially in this area for facial slimming with great results.  I have not seen any evidence of bone resorption.  Best, Dr. Green

Masseter injection with Botox

There was a study I saw that mentioned this phenomenon. It stated there was loss of mandibular bone when Botox was given in the masseters. I think further studies need to be done to confirm this. It hasn't been mentioned at meetings and there have been no clinical manifestations in patients that I have seen.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Bone Resorption with Botox

I am not sure the exact study to which you refer but I pasted a link to the study that I encountered: 

"Botox induced muscle paralysis rapidly degrades bone"


You are correct that the paper implies there is a loss of bone below the muscle being injected. The amount in the femur/tibia is listed at ~50% at just 21 days. While this would imply a significant bony resorption it is important to know that this study is an animal study and analyzes completely different muscle systems from those that are traditionally injected in the face. By my clinical observation I have never seen bone resorption that I would not to be significant as caused by Botox injection however that is not to say it cannot happen. Hope that helps!


Sagar Patel 

Sagar Patel, MD
Houston Physician

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.