30 units of Botox for TMJ (15 each side-one injection per side) and I see no improvement after 5 days. Do I need more? (photos)

Botox is a well-known, accepted and effective treatment for bruxism (teeth grinding) that leads to TMJ pain and for masseter thinning and contouring. I have been performing this procedure for many years, and it is my experience that the amount of this neuromodulator needed to get the job done can vary widely from 15-20 units per side to as much as 50 or more units per side. Since results may take as long as two to four weeks to be fully realized, you would be wise to be patient for the time being. If by a month, you still do not see any additional improvement and remain dissatisfied, you should return to the treating physician or seek a second opinion making certain that you are consulting with a board certified aesthetic physician with expertise in treating the masseters. Best of luck. 

5 days is too early to determine if 15 units per side is sufficient. In some cases, 30 units per side is necessary. The masseter is a strong muscle!

Botox can be injected into the masseter muscle to decrease hypertrophy of the muscle belly, decrease clenching of the jaw, and give a slimming appearance to the face over time. When injected into this muscle, it takes minimally 5-10 days to notice a decrease in clenching of the jaw, however it takes longer to notice the other effects. This muscle is like your gluteus muscle, the more you work it the bigger it will get. So relaxing it with Botox, will reduce its ability to enlarge.  However, it takes a longer period to appreciate “size” reduction.  It can be up to 3-4 weeks before patients will notice a slimming appearance to their jawline. If after this time, you are still wanting more of a result, then more Botox can be administered to the muscle. On average, it takes about 20 units per side notice an effect. It is important to go to an experienced injector who can explain all of this to you as well! Good luck!
In Good Health,

 Ellen Mahony MD    

You should feel a reduction in clenching and tension within 3-7 days.  You are only at day #5.  It is possible that you may require more units.  A good clinical sign is that you may feel fatigued after chewing hard food (meat, carrots, nuts, etc...)   Ask you provider how he assesses how many units he injects and why.   At our practice we have a system in place that is dependent on the size of the masseter muscles so it's not a "guessing" game.   Most people will start to see visible signs of jaw size reduction (V-line) in 4 weeks.   The effects last between 3-4 months and the dosing should be adjusted again at that time.  It's important to find a provider who is skilled at this and can explain their treatment plan in detail.   

Botox to the masseter muscles for TMJ can take 2-4 weeks to see results. Usually 20-50 units are needed per side depending on the strength of your muscles. If you see no improvement after this time follow up with your injector to see if you need more. Best wishes.

Great question! Botox can take 7-10 days to reach full effect and will usually last up to 6 months when injected in the masseter muscle. I suggest seeking a follow-up appointment with your board certified plastic surgeon to discuss if additional Botox should be added. Good luck! 

Dear callmelauren,Botox is generally an on off switch for muscle activity. Most of patients see first changes after 4-7 days and the final results after 10-14 days. It depends on the amount of Botox and area where it is injected but it usually last for 3-4 months.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

It's too soon to tell what your final results will be. It takes 1-2 weeks for final results with Botox. If after that time, you can have a touch-up of Botox if needed. Best, Dr. Emer

Hello and thank you for your question. It can take up to 2 weeks for final results with Botox. I would wait a full two weeks, before returning to your injector. Additional Botox may be needed to get the results you want. Hope that helps.

It can take longer than 5 days to see the effect from a Botox injection.  I would wait at least 2 weeks to see what the results are from the treatment for your TMJ.  If after that time you still see no improvement, I would return to your injector to be evaluated and possibly be treated with additional Botox.