Daxxify for TMJ — When to repeat and concerns about injector technique?

Question

I had my first Daxxify treatment for TMJ about 3.5 months ago (40 units total, 20 per masseter). It helped overall symptoms, but I am starting to get periodic flare-ups and can’t tell if that means it’s wearing off or just normal TMJ variability. How do patients usually know when it’s truly time for another round? Also, my smile felt slightly frozen afterward. I understand placement in the masseter is important to avoid this. Is that something that can usually be corrected with better technique next time? My injector has great pricing, but I’m debating whether to stay and communicate this concern or go to a more specialized (and more expensive) provider. Any insight would be appreciated P.S. I also noticed some facial slimming from the masseter treatment, which I don’t mind overall, but I’m curious if continued Daxxify use typically causes progressive long-term slimming. I’m mainly concerned about maintaining facial balance and natural expression over time

Anna Chacon, MD, FAAD · Answer

You’re asking exactly the right questions, and everything you’re noticing fits very well with how Daxxify behaves in the masseters.

At around 3–4 months, it’s very common to experience intermittent TMJ flare-ups rather than a full return of symptoms. That doesn’t automatically mean the medication has worn off. TMJ is inherently variable and influenced by stress, clenching, sleep, posture, and daily jaw use. Many patients still have meaningful benefit at this stage but notice occasional reminders that the muscle activity is gradually returning.

Most patients truly know it’s time to repeat treatment when symptoms become consistently present, closer to their pre-treatment baseline—such as daily jaw tightness, morning soreness, frequent headaches, or persistent clenching rather than isolated episodes.

Regarding the slightly frozen smile—this is almost always a technique and placement issue, not a problem with Daxxify itself. The masseter sits close to muscles involved in smiling, and if injections are placed too anteriorly or superficially, diffusion can affect those muscles. The reassuring part is that this is very often correctable next time with:

Deeper, more posterior placement

Refined injection points

Sometimes a small dose adjustment

This does not mean you’re a poor candidate, and it doesn’t mean the result can’t be improved.

As for whether to stay with your injector: if they are open to feedback, understand masseter anatomy well, and are comfortable adjusting technique, clear communication alone may be enough. TMJ treatment is more functional than cosmetic, and experience with this specific indication does matter more than pricing alone.

On the topic of facial slimming, some reduction in masseter bulk is expected, especially early on. Over time, the muscle usually reaches a stable plateau rather than continuing to thin indefinitely. Progressive hollowing typically only occurs with over-treatment or overly frequent sessions. With thoughtful dosing and appropriate spacing, most patients maintain good facial balance and natural expression long term.

what you’re experiencing is very typical, the smile issue is likely technical and fixable, and long-term balance can absolutely be preserved with careful management. Your awareness and questions are a strong indicator that you’ll continue to have good outcomes moving forward.

Daxxify for TMJ — When to repeat and concerns about injector technique?

Answers (1)

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