Masseter Botox and Jowls/Marionette Lines (Photo)

Question

I’ve had a consult with a very well regarded and competent injector. They have suggested masseter botox. I am afraid of developing jowls/marionette lines. I have a downturned mouth and full cheeks. Is there a way to look at my facial structure and determine that risk?

Eric M. Joseph, MD · Answer

Based on your photos, your masseter muscles appear to be on the large side. An examination would be needed to confirm this. Do you chew gum? Do you have TMJ issues? I am not aware of TMJ Botox leading to marionette grooves. You appear to have grooves at the corners of your mouth on both sides and depending on your examination, this may be improved with an injectable filler treatment. I hope this is helpful! Sincerely, Dr Joseph

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Masseter Botox primarily targets the masseter muscles on the sides of the jaw, reducing their size and resulting in a slimming effect on the lower face. While it is generally considered safe and effective for facial reshaping, there are potential concerns about changes in facial dynamics that could lead to jowl formation or accentuated marionette lines. Most people have enough elasticity in their skin that it can accommodate the changes that Botox to the masseter is making.

A skilled plastic surgeon or injector will carefully assess your facial structure before recommending any treatment. By evaluating the overall balance and harmony of your face, they can better understand how different treatments, like masseter Botox, may affect your appearance.

I recommend scheduling an in-person consultation with a qualified and skilled injector who can evaluate your concern and determine the treatment plan suited to your needs and goals. Dermal fillers may also be recommended to support the muscles in your lower face.

Jason Emer, MD · Answer

I recommend fillers to soften the nasolabial folds themselves and also lift around the mouth and cheeks to build underlying anatomical support. In our practice we combine Sculptra with other fillers "layered" on top and lasers, skin tightening treatments such as Thermage, Fractora, and Renuvion (J Plasma), thread lifting,  and peels to get the most conservative, natural look. I suggest seeing a facial sculpting expert for a formal consultation. Best, Dr. Emer

Anna Chacon, MD, FAAD · Answer

Botox treatments can offer a quick and simple solution to address lines and a downturn at the corners of the mouth. A few small injections will smooth the lines and relax the muscles pulling down the corners of the mouth for a more pleasant lip appearance and also fillers can help add support and structure to uplift the mouth and restore your smile back to its natural position. Think of it as the filler acting as invisible scaffolding supporting and lifting the corners of your mouth. A filler can be used to temporarily lift the corners of a downturned mouth by providing support to the lip corners.

Amanda Maloney, MD, FRCSC · Answer

Hello and thank you for your question.
It is alway best to have an in person assessment , however, from your photo (especially the oblique pose ) it looks like the chances of masseter treatment adversely affecting the jowl region is small. When you are assessed, one can also see how far anteriorly the masseter extends and this can be a predictor as well. Generally the dose chosen is between 20 to 40 units per side, chosen for the size of the muscle and if you are concerned (and the treatment is not for pain), it is possible to use smaller doses (for example) 15 units per side, reassess in 2 months and repeat treatment if the slimming effect is not sufficient. Finally, I would not anticipate that masseter treatment would pull the corner of the mouth down further but would suggest that you might consider having treatment to the depressor anguli oris. This is the muscle that pulls the corner of the mouth down so weakening it will help deal with this. 
I hope this helps!!Best wishes. .

Martie Gidon, MD, FRCPC, FAAD · Answer

Botox for the masseters can help with grinding and clenching of the teeth and can also slim the face. A small amount can be used initially and then increased if necessary. In a young individual, there would probably not be a change in the jowls and the effect does wear off if you don't like the result. A downturned mouth can also be treated.

Oakville Plastic Surgery &amp; Medspa · Answer

Botox in will cause muscle atrophy the masseter muscle, which makes the muscle smaller. For people who are more likely to present with jowling (usually more likely the older we are), botox in this muscle can make it more apparent. For situations like this, I prefer to use face slimming filler techniques instead of botox. When this is done properly, your cheeks should not appear fuller.Filler can also be used in your lower face to neutralize the downturn of the corners of your mouth by supporting the depressor muscles.

Niro Sivathasan, MBBS, MRCS, DU (Plast), FAACS · Answer

There is no substitute to a clinical (in-person) examination; however based on your spiel and photos, my comments are: (1) Yes, significant use of Botox to masseters may worsen the facial contours of the lower-third; however, step-wise and reasonably conservative use would be fine and should allow you to evaluate in a sequential fashion; (2) I agree that you have downturned corners of your mouth, but it also appears that you have early/ evolving Marionette lines (melomental grooves). Remember this when you evaluate your progress after treatment, so that you are not unduly harsh on your progress. 
I do 'not' think you should add fillers (on their own) to the lower-third of your face (very much over-used).

Camille Cash, MD · Answer

Botox should be used to address the areas that concern you.  If you are concerned with the size of your lower jaw then Botox can be used to help slim this area.  The effects of Botox are temporary, typically lasting three to four months and wearing off gradually over that time.  Results will vary.  If you are nervous you could begin conservatively to determine if you like the effect.  Just be aware that the product may not last as long.  If jowls or marionette lines are concerns then filler can be used to address them.

Masseter Botox and Jowls/Marionette Lines (Photo)

Answers (9)

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