What is the Correct Way to Inject Botox for Jaw/masseter Contouring?

I had botox (Allergan brand) 20 units per side, about 2 weeks ago. But I dont see any slimming on my jaw area. I asked the doctor how deep is he injecting through the jaw muscle. He said he's using the same needle like length for wrinkles. He made marks on where to inject the needle. He said the botox will dissolve down to the jaw muscle. Is that the correct way to inject botox on the masseter for face conturing? Thank you

Doctor Answers 13

Technique for masseter contouring with Botox

I use a 1/2" needle for treating wrinkles along the forehead, Crow's feet and glabella.  The masseter is a far bulkier muscle than the muscles in those areas, so as you can imagine the needle must deliver the Botox deeper in order to achieve the optimal effect.  I use a 1" needle for masseter injections and inject within the body of the muscle just above the bone.  The muscle is covered with a dense fascial layer, so if the injections are placed superficial to this any diffusion of the Botox will be limited by this layer.  The needle must penetrate this fascia and deliver the Botox within the body of the muscle.  

Especially with 20 units per side, additional units may need to administered to achieve maximal effect.  This is common for an initial treatment, and your physician will be able to titrate the appropriate dosage better with future treatments based on your response to this initial treatment.  

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 57 reviews

Botox and masseter reduction

Your masseter muscles are deep and easily detected prior to and during injections. If your provider has said it takes two weeks to show visible slimming, I'd question that. Without seeing you in person, it's difficult to know how many units per side you'd need, but 20 units per side is a small amount for masseter reduction. Size reduction takes a fairly large amount of product. Results take several months to show, and the treatment is on-going.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Botox for masseter muscle hypertrophy

Some people develop large lower cheek girth from their chewing muscles (masseter) enlarging from clenching or grinding their teeth. Sometimes this is related to TMJ syndrome in which the joint of the jaw movement hurts. It is important to treat the muscles symmetrically so there is no imbalance that could exacerbate the TMJ. Injections need to be deep enough to affect the muscles. the enlargement will take time to diminish, even if the Botox was effective in relaxing the masseter muscle activity.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Botox for masseter for jaw contouring

Injecting botox into the massesster muscle can help relax this muscle and achieve a nice softening of the jawline. Using larger doses over a short period reduces the muscle bulk more quickly, while smaller doses over a long period of time reduces the muscle more gradually. I like to inject 20-40 botox units monthly, followed by biannual maintenance injections thereafter. I try to achieve  25% reduction in muscle mass prior to beginning maintenance. In my experience, it can take months for a noticeable change in the jawline to occur.

While 20 units is at the low end of my dosage range, it is still a very reasonable dose. The masseter muscle can be reached with the standard botox needle.

Ramona Behshad, MD
Saint Louis Dermatologic Surgeon
5.0 out of 5 stars 6 reviews

Botox for jaw/masseter

Botox is normally injected into the muscle to obtain the best effect, no matter what area is treated.  For treatment with the masseter muscle, at two weeks after treatment, you should be able to see a difference in the muscle when you clench your teeth.  At this point, the muscle should not clench as much as it did before the treatment.  In regards to the size of the muscle at rest, this will take more time to develop.  Normally the masseter muscle does decrease in size somewhat with Botox, but it takes several months to begin to see this effect.  It may take several treatment sessions to obtain the optimal result.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Masseter muscle reduction technique with Botox - it takes time to work

It will take several months to see a difference and it will take several treatments. In general, 20 units on each side seems on the lower dose but it looks like your doctor is taking the conservative approach. Give it time and be patient.

Hratch Karamanoukian, MD, FACS
Buffalo General Surgeon
4.8 out of 5 stars 41 reviews

Botox for masseter injection for jaw contouring

Botox needs to be injected into the muscle in order to exert its action. So the masseter injections have to be deep enough to reach the muscle.  

It takes time to see the results of masseter injections in slimming down jawline contours, sometimes several months. Some patients with large masseter muscles may need repeated injections during those several months.  Schedules vary.  So it would be too soon to look for results of Botox injections of masseter muscles at two weeks post injections.   

Emily Altman, MD
Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Masseter muscle Botox

The masseter muscle is one of the muscles activated during chewing. It’s located at the “angle of the mandible”, or “angle of the jaw”. Masseter muscle hypertrophy is enlargement of the masseter muscle, and can contribute to a harsh, square look at the angle of the jaw. Botox can be used to relax this muscle, and to soften the look of the lower face. I usually start with 50 units of botox (25 units on each side). When Botox is used to relax the facial muscles that cause fine line, the maximum effect is seen in 7-10 days. When Botox is used to reduce masseter muscle hypertrophy, the maximum effect is not seen for 3 months. Results can last up to 9 months. I recommend repeat injection every 6 months if you would like to maintain your results. 

Dara Liotta, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Botox for facial slimming

Botox is a great way to reduce the Masseter muscle and slim the face. It sounds like you had the correct dosage of Botox injected into the muscle. There are times when it can take several weeks or subsequent injections over time to decrease the size of the muscle. Please consult an expert in Botox for the best results. Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Botox for masseter contouring - timeline for effectiveness

I think you're main concern is that you don't see results in 2 weeks.  I think the sequence is the following:
1) botox injection (20 units per side is an okay starting point)
2) within 2 weeks, you should feel that your muscles can't clench down as hard (you will not notice this if you are eating a salad, but if you try eating a bagel or a steak, you will notice that you're muscles are weaker than usual).  Any change in the width of the face at this point is due to the botox lessening the resting tension in the muscle.
3) Over the course of the next many weeks, the masters will slowly shrink and your face will slowly slim.  This is due to the muscle atrophying as a result of not working as hard (analogy: if you have your arm in a cast for a few weeks, it will be smaller than the other arm when the cast comes off).  

The changes are gradual.  I wouldn't worry about not seeing dramatic results just yet.  But, if your masseter muscle doesn't feel weak, that may be a sign that the botox was not injected properly.

Melissa Chiang, MD, FAAD
Houston Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

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.