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

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?

Doctor Answers 10

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

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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. 

Botox for masseter reduction

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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.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Botox for TMJ

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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 Yamini, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 21 reviews

Botox in masseter

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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.

Time for Botox onset and full effect

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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.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

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

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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.

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 23 reviews

Botox to masseter muscle

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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.

Karen Stolman, MD
Sandy Dermatologic Surgeon

Is it normal to not see improvement 5 days after botox injections?

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

Botox injections for the jaw

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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

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Botox for masseter

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Botox can take up to 2 weeks to work. The slower it works, usually the shorter it lasts.
If this was your first treatment, tell your doctor so the injection and/or dose can be adjusted next time.

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.