Why do some people’s skin sag after Botox masseter muscle? How can I avoid it?

Hello, thank you for your question. Actually, sagging after a masseter muscle injection is actually very rare and the injection is completely safe. However, I would schedule your appointment with a reputable and certified injector before you get the treatment. Good luck!

You can reduce the risk of sagging by starting with a lower dose of botox, using the lowest dose that will give a narrowing result.

The sagging you are describing can potentially happen after treating a very hypertrophic masster muscle. When the muscle is bulky/ thick it acts to hold the lower face "back" to some degree, almost like adding filler to this area does.  When you relax and shrink the muscle the skin in the area may seem more loose.  We inject this area quite frequently and have not heard this complaint from our patients. 

Thank you for sharing your question.  Although nothing replaces an in-person examination, it would be unusual to have masseter atrophy from Botox lead to skin sagging.  Hope this helps.

I have not seen skin sagging develop in patients that I have treated with Botox to the masseter muscles.  

If you have skin laxity in the lower jaw Botox to the masseter muscles may highlight this more in some people. You can consider using treatments such as fillers and Morpheus8 to contour the skin and improve tone and texture. Visit with an experienced injector for an evaluation to learn more.

It is extremely unusual to have skin sagging after masseter muscle reduction with the use of botox. Botox treatment to reduce masseter muscle is an extremely safe procedure especially when performed by a plastic surgeon like myself. I hope this helps and good luck from New York City

I do not do a lot of masseter muscle neurotoxin injecting, but I have never seen any sagging. However, the explanation for why sagging can occur with masseter injection is obvious. If the masseter muscle atrophies (shrinks) from denervation, the volume of soft tissue covered by the facial skin is decreased. If the skin is not elastic enough to shrink to adjust to the decreased volume, sagging will occur. That is why some women get sagging skin on their bellies or breasts after pregnancy or why some people get sagging skin after weight loss.

Patient with jowls, excess skin laxity, and lost of elasticity may notice some sagging related to reduction of masseter muscle bulk. Your physician will evaluate you prior to treatment to determine if you can proceed with the treatment with this happening.

I do a fair amount of injections into the masseter muscles and have never seen sagging as a result of this.  The sagging that you may be describing in more likely related to loss of elasticity of the skin. This will result in jowls or marionette lines in the lower face.