Masseter botox and Voluma cheek filler. How did my face end up worse? (Photo)

Question

So i have a before and after of 22 units per side masseter botox, 4 units daxxify lip flip and 0.7 in total cheek filler. How did my face end up worse? One cheek is almost caved in as well. I look like a picasso.

Randal Haworth, MD, FACS · Answer

I'm sorry to hear that you're unhappy with the results of your facial treatments. Everyone's facial anatomy and response to treatments can differ. The expertise and technique of the practitioner performing the treatments can significantly impact the final results. It's important to choose a qualified and experienced professional who specializes in facial aesthetics and has a track record of producing desirable outcomes.

In some cases, seeking a second opinion from another qualified and experienced practitioner in facial aesthetics may also be beneficial. They can provide an independent assessment and offer guidance on potential corrective measures if necessary.

I hope this helps,
best of luck !

A.J. Amadi, MD · Answer

There are a lot of things to consider here- when did you have these initial injections? Did you follow the post care instructions? Did you lose any weight after these injections or do you have any underlying autoimmune diseases? There are risks to any injections. Fillers can migrate over time from the area they were placed in, sometimes they can even cause nodules. Getting masseter Botox can cause jowling on some candidates. When you relax the masseter muscle, it causes atrophy to the muscle and that muscle is holding up your skin and keeping it pulled back. So when the muscles decreases in size (this doesn’t mean it will be decreased in size forever) the skin that was being help up by the muscle falls and can cause a jowling.

Mahmood Siddique, DO · Answer

It’s understandable to feel frustrated when cosmetic treatments don’t deliver the outcome you expected. Here’s what may be contributing to your concerns:
1. Masseter Botox Effect
Masseter Botox reduces the bulk of the jaw muscles over time. In some individuals, especially those with naturally lean faces, this can create a hollowed or sunken look in the lower face as volume decreases. It typically takes a few weeks to see the full slimming effect, which may accentuate asymmetry if facial volume is already imbalanced.
2. Cheek Filler Placement
With only 0.7 mL total used for both cheeks, the volume may have been too subtle to achieve noticeable lift or balance. If the filler wasn't evenly placed or if your natural facial structure is asymmetric, it could emphasize differences rather than correct them.
3. Lip Flip Contribution
While unrelated to the cheek or jaw, a lip flip can subtly change facial proportions and draw attention to other areas&mdash;especially if the lower face is undergoing structural change from Botox and filler.
What You Can Do
Reevaluation by your injector is key. A touch-up or adjustment (e.g., adding more volume to the deficient side or dissolving uneven filler) may help restore symmetry.Masseter Botox wears off gradually over months, so its effects aren’t permanent.If the hollowness persists, strategic filler placement or skin-tightening treatments may help restore balance.
A conservative and customized plan going forward can help you feel more confident in your results.

Eric M. Joseph, MD · Answer

It's difficult to pinpoint exactly what has changed based on your before and after photos, however, if some of the neurotoxin was injected into your resorious muscle, that can cause a subtle change in the appearance of your facial shape, especially with smiling. The effects of Botox will completely wear off. I hope this helps. Sincerely, Dr Joseph

Jonghyun Hong, MD · Answer

Hello,
This is Dr. Hong from Fresh Clinic (Seoul).
What you're noticing is a result of the masseter Botox treatment. While Botox can be effective for some individuals, in your case, it has caused a temporary loss of jawline support due to the relaxation of the masseter muscle. It's important to allow the muscle time to heal naturally. Typically, after about six months, the Botox effects will subside, and the muscle tone should gradually return.
I also recommend avoiding additional treatments, such as fillers or Sculptra, for volume restoration at this time. The best approach is to refrain from further injections for a while to give your muscles time to recover.
If, after several months, you do not see noticeable improvements, options like liposuction to reduce bulkiness in the lower part of the face, along with some lifting treatments, could help to address the issue.
Best regards,Dr. Hong

Falguni Patel, MD, FACOG · Answer

What you are seeing is a result of the masseter Botox you had done. Although, masseter treatment can be great for some, due to your anatomy you lost the support of your jawline by relaxing the masseter muscle. I would avoid doing in again unless you need it for pain relief. You can look into other treatments to contour the lower face such as microneedling treatments with radio frequency or fillers.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your experience and posting your photos. It appears the Botox and/ or filler was placed without creating the most symmetrical results possible. Also, the Botox should be placed first in order to see the results 1 week later. At that time filler should be placed. I hope this helps.
Good luck,

Joshua T Halka, MD · Answer

If you had your masseters injected, it is a known side effect that they can become smaller when they are less active. If you remove the volume of the masseter it can cause wrinkles and/or sagging in other areas of your face. Additionally, if your cheek being caved in is where it looks like you have dimples in one of the pictures, it may be possible that the botox also affected the buccinator muscle (people who have dimples have them in the buccinator muscle). Give the botox time to wear off and your muscles to regenerate.
Hope this helps!-Dr. Halka

Ali Ghafouri, MD · Answer

While treating the masseter muscles with Botox is a huge relief for those who suffer from TMJ, it does "slim" the jawline. As the muscle atrophies from the Botox, it reduces in size. For most patients this is a desirable look. For some patients the reduction can case slight "jowling" . Filler for mid-face will help with the jowling, however, the 0.7 is so minimal, it will really have no effect at all. I would recommend budget to get 2 syringes for mid-face. This will give a natural and youthful look, as well as reduce the look of "jowling". You may also consider requesting a filler with a Bio-Stimulator, such as Radiesse or Bellafill.

Jason Emer, MD · Answer

Botox results last up to 3 to 4 months and can be softened with Venus Legacy and Thermage treatments. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

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