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 11

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.

Manhattan Dermatologic Surgeon
5.0 out of 5 stars 38 reviews

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.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 41 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
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 194 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 17 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.

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

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.

Botox technique for masseter injections.

Thank you for your question. Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep. Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox wears off completely.

As far as depth, the masseter muscle is a much bigger and deeper muscle than the frown, crows feet or forehead muscles.  I would make sure that your injector is well experienced with this region as it is considered a more advanced technique.

Botox Injections are Effective for Masseter Muscle Reduction on the Face (slimming of enlarged jaw area)

Botox Injections are Effective for Masseter Muscle Reduction on the Face (slimming of enlarged jaw area). Typically, 20 units per side may be an adequate dose. Depending on the size of the enlarged masseter muscle (biting down/chewing muscle), larger doses may be used at times. The first treatment session may require slightly greater doses to exert a noticeable effect. Either a 1/2-inch or 1-inch needle may be used for the injection, depending on overlying skin thickness and as long as the injector can reach and properly inject the masseter muscle. 

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.