Botox in the jawline. Does this cause further sagging of skin?

I have some mild sacking around the jawline area and nasolabial fold. My doctor recommended that I think about having Botox to reduce the Masseter muscles in my jawline. My worry is that if I have the Botox to shape the jawline won't this mean that there is less support for the skin above it and therefore cause more sagging in the lower face itself? Not sure if I've explained it very well, but hope that makes sense.

Doctor Answers 8

Botox in the jawline. Does this cause further sagging of skin?

Thank you for your question. The masseter injection decreases the bulk of that particular muscle. It is unlikely it will effect the surrounding volume. That being said, it may effect the skin around the masseter muscle. 


Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Botox for the jawline and sagging skin

Botox would definitely not be the treatment of choice in the jawline for sagging skin.  The best combination would be Thermage for skin tightening which would improve the jowls non-surgically and Sculptra to produce more volume that has been lost.  If there is a "double" chin, then Kybella injections will dissolve the fat and improve your jaw line.  These are all advanced techniques so please consult an expert.  Best, Dr. Green

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

Jawline Botox

Hi there, 

Interesting and sensible question. In principle paralysis of any muscles of facial expression will result in relaxation of the muscle vectors around the jaw line, if anything increased paresis of these muscles will result in at least mild loosening of skin and soft tissues around the jowels even if marionette lines improve a  little. 

Ross Farhadieh, MBBS, MD, FRACS, FRCS
Sydney Plastic Surgeon
5.0 out of 5 stars 11 reviews

Botox and skin sagging

Your logic is very well founded. If your primary concern was a wide jawline then Botox would be the treatment of choice, however for the nasolabial folds correction the same does not apply. Hope this is helpful.

Botox in the jawline

Botox in the masseter muscle can be used to decrease masseter muscle hypertrophy or for patient's that grind their teeth.  A larger masseter is usually associated with a more masculine jawline and may provide some support to lateral sagging of skin.  Masseter muscles take time to shrink with repeated botox injections and is a slow process, but these injections usually do not help with sagging skin.  Generally, to improve the jawline, botox is used in the neck (platysma) and lip depressor muscles; these injections can lift the neck and corners of the mouth. 

Kyle Coleman, MD
New Orleans Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

Botox to masseter

Usually you will not see increased sagging after injection into the masseter muscle.  It is verfy patient specific and without an evaluation I cannot comment on your specific concerns.  Good news is that the treatment result is not permanent, so if you have sagging it will get better once the medicine wears off.  I would not be too worried, and chances are you will enjoy a very nice result.  Best Regards

Sean R. Weiss, MD, FACS
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Botox and sagging jawline

I would agree (without seeing pictures) that your concerns about increased sagging could occur with a reduction in the size of the masseter muscles. When you deflate the underlying volume of the face, you can certainly see some increased drooping. However, I would also recommend you talk to your physician about this and obtain another evaluation

Robert J. Smyth, MD
Cincinnati Facial Plastic Surgeon
3.5 out of 5 stars 11 reviews

Botox to treat a slightly sagging jawline is an indirect approach - the direct approach is treating volume loss at the jawline

Thank you for your question. You say you have mild sagging along your jawline, for which your doctor suggested Botox™ injections in the masseter muscle, but you’re worried this may cause more sagging.

A bit of info on my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. A big part of my practice is focused on facial aging and facial rejuvenation, so I can certainly share my experiences in using Botox™, which I’ve been using since the early 90s.

The masseter muscle is an important muscle for chewing. Some people have a thickened masseter muscle that produces an undesirable looking bulge. In such cases, there is a role for Botox™ to reduce the volume of that muscle without affecting its functionality.

What we do in our practice in order to address the masseter muscle, as well as the other muscular structures along the jawline is a procedure called the Y Lift™. The Y Lift™ makes use of fillers, such as Juvederm Ultra Plus and Voluma, which are then placed in a very specific and elegant way in the deeper structural levels of the face, under the muscles and near the bone structure. It restores volume and definition to areas like the jawline and chin.

I think there may also be a slight misinterpretation of the term “sagging”. It’s important to understand that there is sagging and there is volume loss. When you describe sagging in the jawline that is very little, it is more likely that most of your issue has to do with volume. So rather than performing a surgical facelift where we lift the skin, soft tissue, and muscle, we can instead place volume in the deeper structures of the face. You not only get better definition, the whole face looks younger. The beauty about this procedure is that you can do it on specific areas of the face, such as only the jawline, or only the cheeks.

I think your doctor may have felt that the continuity of your jawline may be better improved by reducing the volume of the masseter muscle and by perhaps making the jaw look straighter, however, I think it’s an indirect approach that may not generate the type of result you’re looking for. I recommend that you learn more about the Y Lift™. I think this may be a worthwhile option to consider, especially if you only have minimal sagging.

I hope that was helpful and I wish you the best of luck!

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 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.