Please help! Do I need a facelift? Masseter Botox 2x and cheek filler 1x ruined my face (Photo)

Question

Please help!I had masseter botox as recommended by derm for aesthetics(not a grinder) and cheek filler Apr 2023 and my face rapidly got thin. My skin couldn't keep up and I got jowls. In Nov 2023 I had a Nefertiti lift for jowling and she got my masseters again! Now its been a year since last masseter toox and my face is thin and jowly. I've tried jawsercize and chewed so much gum but only my temples are growing. Also my smile looks doughy like I've had novacaine. Will I ever return to normal?

Lucian Ion, FRCS · Answer

Thank you for your inquiry and sharing your photographs. 
When the skin elasticity has decreased, reducing the volume of the masseter muscles can produce more visibility in the jowl region through two mechanisms.
First, the relaxation of the skin along the jawline, which accumulates more in the jowl region. 
Second, it is a perceptual element because the volume reduction of the masseter does not decrease only the width, but also slightly the height of the jaw. This produces an impression that the contour next to it in the jowl region is more pronounced. 
Without having to do any special exercise, the tendency is for the masseter muscles to restore their fullness and for the jawline contour to return to the pre-existing appearance. 
Bear in mind also that over time, the tendency is for the laxity along the jawline to increase. So if there is a sequence of events covering a year and a half or two years of non-surgical treatments, sometimes even when the volume of the masseter muscle is back to the starting point, there can still be slightly more visibility of the jowls, although this tends to be very discreet, over an interval like this. 
The smile can sometimes be affected by a degree of diffusion of the botulinum toxin towards the buccinator muscles or the risorius muscles, but I cannot say that I can see evidence of this in your photos. 
The differences in the appearance of the smile seem to be mostly related to the support generated by the volume of the masseter muscles. 
A facelift intervention can produce more significant balancing of the facial structures, but I would suggest to wait until the masseter muscles have restored their volume before making this assessment and decision.

Stephen Prendiville, MD · Answer

Great question! The changes noted in your photographs, which include mid-facial descent, jowling, and neck obliquity are best addressed with a deep plane facelift.  You may want to consider upper and lower eyelid blepharoplasty at the same time in terms of complete facial rejuvenation.  This is an emotional decision that has rational roots since the natural aging changes we see aren't ones we had fully anticipated. A virtual or in person consultation would provide better answers.

Nashielli Torres Espinosa Chiu, MD · Answer

Thank you for sharing your story &mdash; I can understand how frustrating this must feel.
The good news is that Botox is temporary, and its effects on the masseter muscles will gradually wear off over time. As the muscle regains volume and tone, some of the facial balance may return naturally. However, based on your description (and especially if jowling and skin laxity have persisted), it’s possible that the loss of support from the muscle combined with volume shifts from filler may have affected your overall facial structure.
In these cases, a facelift can be a powerful solution. By repositioning and lifting the deeper facial tissues (especially in the lower face and jawline), it can restore a more youthful and refreshed contour, addressing jowls and improving definition &mdash; regardless of prior Botox or filler treatments.
You’re not alone in this experience, and with the right plan, there is definitely a path to feeling like yourself again &mdash; or even better.

Gianfranco Frojo, MD · Answer

I would recommend to stop any more injections. I would recommend seeing an American Board of Plastic Surgery certified surgeon to discuss facial surgery options. You are an excellent candidate for a deep plane facelift/necklift with fat grafting.

Andrew Miller, MD · Answer

Your neck doesn't look too bad so a good minifacelift will work well for you. You also have some typical aging at your nasolabial and labiomandibular folds that fat transfer will help at the same time. Be sure to see a facial specialist for consultation.

Jacob Tower, MD · Answer

Hello, hope you are well. Your face is aging, and trying to enlarge your masseter muscles will not help (but it may cause TMJ issues). The jowling that you point out and loss of jawline definition is best reversed with a surgical facelift. Good luck!

Best,
Dr. Tower

Best,
Dr. Tower

Jeffrey H. Spiegel, MD · Answer

The botox may not have helped, but it didn't cause this problem. This is aging. Don't try to increase muscle size by chewing, etc.
There are many things we can do.  A small lift is likely the best option,

Michael S. Kluska, DO · Answer

As we age, the bones in the face and fat in the face shrink and as a result, the skin and muscles begin to sag. That said, you would do great with a deep plane mini facelift + upper and lower eyelid tuck combined with fat grafting and possible small chin implant (hard to tell in these pics). All of this, would allow your surgeon to balance your facial structures and put them into more harmony.

Darryl J. Blinski, MD · Answer

Based on your post photos, you were candidate for a mini face neck lift with SMAS plication with Endo lift treatment fee from $10,000-$15,000. Best of virtual consult with.

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