Botox treatment to Masseter muscle has caused jowl. Is this permanent?

Last year I had Botox injections (4 in total) to my left masseter to treat hypertrophy. This worked well in reducing the muscle bulk but the last injection 5 months ago also caused considerable volume loss to my left cheek. Volume has returned but not as full as before. What is really concerning me is that I have recently developed a jowl on this side of my face which I did not have before. I am scared this is permanent. Will this disappear in time? Will using a facial exerciser help? I am 52.

Doctor Answers 3

What it out

Sorry to hear that you're not happy with your results. I suggest you wait a couple of months to see if your face doesn't return to normal, then talk to your injector about your concerns. I don't recommending using a facial exerciser, since that can actually contribute to the wrinkles Botox helps to smooth away.

Botox and Jowls

Very difficult to answer your question without pictures. In general Botox injections  in the masseter muscles will cause a decrease in the volume of the muscles but it is usually a temporary effect. As you are using the muscles for mastication  it will bulk up again. 5 months post botox injection is not long, so it may take few more months for the volume to get restored. 

Henri P. Gaboriau, MD, FACS
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

This is Not Something We See Too Often

Thanks for your question and I am sorry that you are having the concerns that you are having. Injections into the masseter are very technique dependent and it seems that your injector was skilled in reducing the masseter for you in the past. Now that you are having a concern, it would be really important to review the before and after pictures, as what you are describing is not something that we hear about or see too often from Botox injections in this area. I am wondering if you had some volume loss in the first place which is now something that is becoming more pronounced over time and that the jowl is there as the masseter is made smaller. Please consult with a board-certified dermatologist or plastic surgeon to determine what is going on and what the best treatment options are out there for you now, including the use of RF energy based devices if this is deemed appropriate.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 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.