is it normal to not see improvement 5 days after botox injections in the masseter muscles?

Question

Hello, I had botox injections for TMJ 5 days ago in my masseters and in my trapezius muscles. I don't feel as much pain in the trapezius anymore but it has not improved the spams in my jaw muscles at all. Is it supposed to take longer than 5 days or is it just not working for me?

Donald B. Yoo, MD, FACS · Answer

Most patients will have see full effect ~7 days, but some patients will not observe full results for ~2 weeks.  Especially for a bulky muscle as the masseter, the full effect of Botox will have "kicked" in by 2 weeks, but the visible reduction in size may take up to a month.

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep.  Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox  wears off completely.

Bahman Guyuron, MD · Answer

Yes, you may see the paralysis as early as 3 to 10 days but it may take 6-8 weeks for the muscle bulk to reduce substantially.

Daniel Yamini, MD, FACS · Answer

Botox is very effective for treatment of TMJ, masseter hypertrophy, or tension in the temporalis and masseter muscles causing symptoms and headaches.  The effective dose varies quite a bit between individuals.  I usually start with 6 to 8 units in each muscle and gradually increase the dose based on patient feedback.  It takes up to 2 or occasionally 3 weeks to feel the full effect of Botox.

Daniel Shapiro, MD · Answer

Some patients begin to see results just a few days after the injections, however it is normal to not see big results after 5 days. Everything typically appears around the 2 week mark from the injections.

Benjamin Barankin, MD, FRCPC · Answer

While most people will see cosmetic improvement starting at 3-4 days and full improvement by 10-14 days, the bulk reduction of muscle and pain reduction can take 1-3 months to see the necessary results. Sometimes however, you may be underdosed (e.g. if its your 1st time) and may require more units of Botox in subsequent treatments. ~ Dr. Benjamin Barankin, Toronto Dermatology Centre.

Karen Stolman, MD · Answer

If it does not seem to be working in your masseter by two weeks, find out how many units were placed and if you many need more.  I usually treat each masseter with a minimum of 12 units, or 24 total for both sides.

Wesley T. Myers, MD · Answer

Injection of this Botox into a muscle causes weakness or paralysis of that muscle. The paralysis generally appears within 14 days.

Chase Lay, MD · Answer

I hope you didn't inject your trapezius muscle. Do you mean your temporalis muscle?It can take as long as 10 days to really work.  You also may require a more substantial dose.  If for some reason you the masseter muscle injected that not the temporalis muscle you may consider injecting the temporalis as well.  Follow up with your doctor.Chase Lay, MD Double board certified facial plastic surgeon

is it normal to not see improvement 5 days after botox injections in the masseter muscles?

Answers (9)