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WHAT IS MASSETER BOTOX PROCEDURE?

The bilateral masseter muscles are the primary muscles that allow you to chew and open or close your mouth. However, when they grow exceptionally strong and become hypertrophied, they cause a variety of conditions including temporomandibular joint dysfunction (TMJ), excessive teeth grinding and clenching (bruxism), and the appearance of a square-like lower face. If you suffer from masseter muscle hypertrophy resulting in TMJ or bruxism, or simply want to slim down your jawline for a softer-looking face, masseter muscle injections with Botox may be an excellent option for you!

Botox injection into jaw muscles is a minimally invasive procedure in which botulinum toxin (BoNT) is injected into the masseter muscles to slim and contour your lower face and to manage facial pain and jaw tension associated with temporomandibular conditions. Jawline treatment with botox is considered “off label” and should only be performed by board-certified physicians with extensive experience in injectables and cosmetic medicine, like Dr. Schwarzburg.

Research based on randomized controlled clinical trials comparing intra-masseteric Botox injections with placebo, found that neurotoxins effectively treat bilateral and unilateral masseter muscle hypertrophy. It has also been found to effectively contour and reduce the size of the jawline, alongside various medical applications including TMJ disorder and its associated unpleasant symptoms.

WHAT IS MASSETER MUSCLE?

The masseter muscle spans the mid to lower face from the angle of the mandible to the zygomatic arch and is the primary muscle responsible for the functionality of the lower jaw, such as chewing, alongside the temporalis and pterygoid muscles. An overactive and overworked masseter has a boxy, square look when hypertrophied or enlarged, which many patients find unflattering, particularly in the female population.

WHY DOES THE MASSETER MUSCLE ENLARGE?

There are a number of reasons why the size of this muscle may enlarge, including:

  • Bruxism
    A condition associated with excessive teeth grinding and clenching of the jaw that is often caused by stress and genetics.
  • TMJ (temporomandibular joint dysfunction)
    A common joint disorder between the mandible and temporal bones, causing headaches, tenderness, tightness, teeth grinding, and a wide array of other symptoms which can lead to jaw clenching and the enlargement of the masseter muscle. Based on research from the National Institute of Dental and Craniofacial Research, approximately 10 million Americans suffer from TMJ.
  • Excessive chewing
    Sometimes excessive chewing due to mandibular mechanics or chewing on only one side of the mouth, can cause asymmetry in the lower face and jaw, as the muscles of mastication (the group of muscles responsible for chewing) become stronger as we chew.
  • Genetics and ethnicity
    Many patients are genetically predisposed to stronger or increased jaw muscles or masseter muscles. Research has demonstrated a correlation between the skeletal malocclusion of the mandibles and the changes in genetic and epigenetic expression of the masseter muscles.
Botox masseter reduction

WHAT IS BRUXISM?

Bruxism, more specifically sleep bruxism (SB) is a condition that affects 8.6% of the general population and is known for involuntary teeth grinding and jaw clenching, which can lead to several symptoms including chronic jaw pain, clicking in the jaw, the inability to open your mouth or jaw all the way, tension, and a variety of other aches and pains.

WHAT CAUSES BRUXISM?

Stress is one of the most common contributing factors to bruxism, though certain medications, caffeine, and alcohol, various sleep disorders, as well as familial factors may also contribute to the development of bruxism.

Botox jawline reduction

DOES BOTOX HELP WITH BRUXISM?

Botox has been extensively researched and is clinically proven to be an effective treatment for bruxism and is able to reduce the frequency of its episodes, as the toxin paralyzes and relaxes the masseter muscles along the jaw, relieving the tension that causes all the negative symptoms linked to bruxism.

WHAT IS TEMPOROMANDIBULAR JOINT SYNDROME (TMJ)?

Temporomandibular joint syndrome, also called TMJ, is a condition prevalent in 30% – 44% of the population, primarily the younger population and women, in which the patient experiences severe joint and jaw pain or tenderness, earaches, lockjaw, ringing in the ears, and headaches. TMJ goes hand in hand with Bruxism as both are located in the jaw and masseter area with very relatable symptoms.

CAN BOTOX INJECTIONS BE USED AS TMJ TREATMENT?

Yes! Botox Cosmetic is clinically proven to work as a treatment for TMJ as it relaxes the masseter muscles upon injection, reducing all of the symptoms associated with the condition. Because TMJ affects such a large percentage of the population, up to 25% of persons struggling with temporomandibular disorder seek medical care to treat it. 

Relieving TMJ pain

In addition to neuromodulator injections, Dr. Schwarzburg recommends reducing the amount of chewing gum or chewy candy you consume as the masseters are instantly activated during chewing. As TMJ is often associated with tooth grinding, a mouth guard at night can exponentially reduce the harmful effects the disorder may pose on your teeth.

HOW DOES BOTOX WORK TO REDUCE THE MASSETERS?

The primary reason for the enlargement of the masseter muscles comes down to the increased muscular hypertrophy of the muscle itself secondary to the above-mentioned factors.

After the discovery that Botox has pain-relieving qualities after treating oromandibular dystonia and cervical dystonia, it was FDA approved and regularly used to treat TMJ and myofascial TMD. 

When Botox, an exotoxin produced from clostridium botulinum, is injected into the three primary muscles involved in TMJ including the temporalis muscle, masseter muscle and lateral pterygoid muscles, it blocks acetylcholine from sending nerve signals to the neuromuscular junction, causing it to atrophy. This results in the reduction in strength and size of the masseter, as well as the mitigation of side effects such as chronic myofascial pain linked to conditions such as TMJ and bruxism.

BOTOX FOR MASSETER REDUCTION VS JAW SURGERY 

Botox injections for facial slimming are quick and painless in which a custom number of Botox units are injected into the chewing muscle, resulting in a slimmer and more defined lower face and jawline. While it is not permanent, it is minimally invasive and involves no downtime, making it an attractive choice for adjuvant therapy for many patients.

Surgical jaw reduction involves breaking and shaving down parts of the jaw bone to permanently reduce its size. While effective, plastic surgery procedures always include a higher risk for side effects and irreversible complications. In some cases, arthrocentesis or arthroscopic surgery is needed to treat temporomandibular disorders, though they are predominantly only carried out as a last resort after failed attempts of minimally invasive alternatives.

DOES BOTOX REDUCE SAGGING JOWLS?

While Botox jaw muscles injections are commonly used to reduce the overall size of the lower face, they can not reduce sagging jowls, since its fundamental purpose is to address the jaw muscles, and not the skin and the underlying tissues directly. However, botox for jaw slimming can be combined with other non-surgical modalities such as a PDO thread lift, which will effectively lift your jowls. 

Jowl sagging results in the loss of the definition of a strong mandibular border and is a common concern among patient who are approaching their 40th anniversary. The root cause for jowling is inferior-medial displacement of fat pads and weakening of the facial suspensory ligaments. Because Botox only addresses hypertrophied masseters it has no direct impact on lifting the skin around the jawline and in some cases can even exacerbate the appearance of jowls. Ligamentous laxity and midface ptosis that are common hallmarks of an aging face can be effectively dealt with minimally invasive procedures such as PDO threadlifting, especially in the initial stage of the facial aging process.

Jaw thinning botox injections have become increasingly popular in both male and female patients to treat medical conditions such as TMJ, bruxism, and migraines, and for aesthetic purposes to decrease the square-like appearance of the lower face. Temporomandibular dysfunctions and pains are common and are frequently treated using intramuscular Botox injections into the affected muscles. In addition to medical application of the drug, Botox is used aesthetically in patients who want to soften and reshape their lower face and jawline, even out asymmetry, and create a V-shape or heart-shaped lower face in a minimally invasive nature.

Because of its minimally invasive nature and natural-looking results, neuromodulators, such as Botox, are an appealing alternative to other methods used for jaw reduction such as its surgical counterpart.

CAN BOTOX COSMETIC BE USED TO SLIM AND CONTOUR YOUR FACE? 

Yes! Botox causes the muscle in which they are injected to relax by inhibiting the release of acetylcholine and thus, relaxing the treated area. This can be compared to working out other muscles: when you lift weights, your muscles become stronger and grow in size; when you stop working out, they become more relaxed, weakened, and consequently decrease in size and volume.

HOW DO I PREPARE FOR NON SURGICAL JAW REDUCTION INJECTIONS WITH BOTOX?

Masseter Botox treatment does not require any type of preparation, though there are some precautionary steps that you can take, including discontinuation of blood thinners, such as aspirin, to prevent excessive swelling or bruising along the jawline post-injection.

Before your masseter injections, you should always confirm with your physician that you are a candidate to limit the risk of potential side effects or unsatisfactory results. In addition, be sure to do your research and find an injector who is a board-certified cosmetic physician with extensive experience in minimally invasive and injectable treatments to ensure a safe and worthwhile experience.

WHAT IS THE PROCESS OF MASSETER RESHAPING USING BOTOX?

Before the actual Botox administration, you will first have a consultation with Dr. Schwarzburg in which he will palpate the jaw muscles manually to examine their strength and your facial bone structure. You will also have the opportunity to discuss any questions or concerns, and inform Dr. Schwarzburg about your medical history to confirm your candidacy for the jaw thinning treatment.

Once confirmed, the area will be sanitized using alcohol, and Dr. Schwarzburg will inject the medication into 4-8 injection points in each cheek to precisely inactivate the jaw muscles.

After the injections are complete, Dr. Schwarzburg will sanitize the area one more time to prevent the risk of infection, and you will be sent home with an ice pack to reduce swelling or bruising.

HOW LONG DOES A MASSETER BOTOX PROCEDURE TAKE? 

Botox jawline contouring procedure takes approximately 10 minutes. This is variable depending on the number of units injected and your overall pain tolerance. However the duration of the treatment rarely exceeds 15 minutes as there are very few injection points needed to achieve optimal results.

HOW MANY UNITS OF BOTOX ARE NEEDED FOR A NON-SURGICAL JAW REDUCTION?

The number of units of neurotoxin needed for non-surgical jaw reduction is variable. On average, most patients need 20 to 50 units of Botox per 1 side for an aesthetically pleasing and effective jaw reduction. In some cases, a patient may need up to 70 or 80 units per side if their masseters are hyperactive or they have variant anatomy that predisposes them to strong clenching. If a patient has asymmetric masseter muscle hypertrophy, then the number of units used may differ between both sides of the mandible.

WHAT IS THE AFTERCARE AND DOWNTIME FOR NON-SURGICAL JAWLINE REDUCTION?

Botox injections in the masseters require only minimal aftercare. After your treatment you can resume almost all daily activities except for heavy and strenuous exercise routine. Avoiding alcohol consumption for 24 hours after treatment will help reduce bruising along the jawline and in the cheeks. Another key factor to keep in mind is to avoid rubbing or massaging the masseteric region for 2 days post procedure to avoid non-targeted diffusion of the medication. To reduce post-procedural swelling you may apply an ice pack or a warm compress for bruising along the jawline of masseteric injections.

ARE THERE ANY SIDE EFFECTS ASSOCIATED WITH BOTOX INJECTIONS TO THE MASSETERS?

When administered by a board-certified physician non-surgical jaw slimming Botox injections have a limited list of risks and side effects, including muscular tenderness, redness, swelling, and bruising which may last for 1 – 5 days. The effects are usually short-lived and do not interfere with activities of daily living. Visual skin discoloration due to ecchymosis (brusing) can be effectively camouflaged with a concealer.

More serious side effects linked to jawline slimming using Botox include asymmetry caused by paralysis of the rhizorius muscle, which can occur if the toxin is injected superficially to the masseter muscle. Most common presentation for an erroneous and partial rhizorius paralysis is a crooked or asymmetric smile. This uncommon complication is not permanent and will fade in 3-5 weeks post-injection. To help alleviate the negative consequences of this side effect, patients are advised to exert muscular activity by forceful smiling and other facial expressions. Sometimes a special muscle stimulator can be used to help recover from this unwanted side-effect. 

The best way to avoid any risks or side effects is to have your jaw muscle reduction administered by a board-certified physician with extensive knowledge of the facial anatomy and the expertise to properly execute the procedure.

While Botox is deemed safe for jaw slimming by the FDA it is crucial to remember that they it is considered “off label”, meaning that only highly experienced and qualified doctors are allowed to perform this highly advanced procedure.

HOW LONG DOES IT TAKE TO SEE RESULTS FROM BOTOX INJECTIONS IN THE JAW?

Results from masseteric Botox injections are usually separated into functional muscular inactivation and visual muscular debulking. Functional paralysis results in decreased strength of the bite and teeth clencking with almost immediate relief in pain and jaw tenderness. This process usually takes 3-5 days to fully materialize. 

On the other hand, jaw slimming manifested by a more pronounced heart or V-shaped lower face is usually apparent within 2-3 weeks after the procedure as it takes this amount of time for the masseters to atrophy through the process of muscular volume loss. 

Dr. Schwarzburg always recommends to schedule a 1 month follow-up to assess the results of masseteric injections to make sure you have achieved your desired jawline result and make any adjustments if necessary.

HOW MANY BOTOX PROCEDURES ARE NEEDED FOR JAW REDUCTION

For the average patient, a single session is enough to observe a noticeable difference in the size and shape of the lateral jaw along the angle of the mandible using any of the FDA approved neurotoxins. Some patients, primarily those that are new to Botox in the masseters, require touch-up appointments in the following 3-4 weeks until the proper amount of Botox has been injected for optimal results. As jaw slimming results wear off as the Botox is gradually metabolized by the body, maintenance appointments are required every 3 – 4 months to preserve the original results. It is also advised to avoid frequent monthly touch-ups as Botox resistance tends to develop thereby reducing the efficacy of the injections. Research has shown that follow ups every 3-4 months are best suited to avoid developing neutralizing antibodies to the protein components of Botox compound.

HOW LONG DO BOTOX MASSETER REDUCTION RESULTS LAST?

The jaw slimming results accomplished through intramuscular neurotoxin administration last indefinitely depending on the frequency of your treatments. Without a touch-up, the initial results will last 3 – 6 months. With regular touch-up appointments (3 – 4 month intervals), your results may in essence last forever.

HOW OFTEN SHOULD I GET BOTOX FOR JAW SLIMMING?

In order to maintain your botox-augmented jawline, you should get regular touch-ups in 3 – 4 month intervals. The general rule of thumb is to schedule your maintenance appointments once the results have worn off by 85 – 90%, preventing them from diminishing completely, bringing you back to square one.

WHAT WILL MY BEFORE AND AFTER V-LINE RESULTS LOOK LIKE?

Before your masseter Botox injections, you will likely be experiencing uncomfortable and lifestyle-limiting symptoms associated with TMJ and bruxism, such as teeth grinding, jaw clenching, headaches and migraines, soreness and tenderness, or simply have the desire to reduce the size of your jawline for aesthetic purposes. After your masseter Botox treatment, the above mentioned symptoms will be minimized or fully eliminated, and the size of your chewing muscles and lower face will be reduced and evened out for a more snatched and draped look.

HOW MUCH DOES JAW NARROWING WITH BOTOX COST?

The total cost of Botox to slim down the masseters ranges $500 – $1000 per single session depending on the following fundamental factors:

  • The number of units that is needed to accomplish each individual patient’s desired results. While most patients require an average of 20 – 25 units per each side for this jawline reduction treatment, others may require additional units if their masseters are particularly strong. Masseteric strength is determined by having the patient clench their teeth with maximum effort, so that complete muscular contraction is achieved. The strength of the masseters is then graded on a scale of 1-5 with 1 being the weakest and 5 being the strongest. Most patients are grade 3 and require 20-25 units per side, however it’s not uncommon to have up to 70 units of Botox injected per side to achieve acceptable results. 
  • The qualifications and credentials of your provider – slimming the jawline using Botox requires a complex course of action, and thus, requires not only a qualified, but skilled injector. A board-certified physician with extensive experience in this particular field of medicine will likely charge higher than a nurse practitioner. Masseteric anatomy is complex and frequently exhibits variations from standard anatomic landmarks. If that variant anatomy is missed or not taken into account during the planning and injection process, unwanted side-effects may ensue that will take long time to resolve, and may negatively effect patient’s emotional status and limit their social and professional interactions. 
  • The geographic location of your provider – in order to successfully reduce the size of one’s masseters, the proper number of botox units must be injected. Practices located in larger cities such as New York or Los Angeles often have a higher per-unit rate than other providers located in more rural areas.

WHAT PROCEDURES CAN BE COMBINED WITH BOTOX TO IMPROVE MY JAWLINE?

There are several minimally invasive cosmetic treatments that can be used in conjunction with Botox to improve the appearance of your jawline, including dermal fillers like Juvederm, Restylane, and Radiesse, which are used to shape and define the angle of the mandible by creating the appearance of a more chiseled or “snatched” chin and jawline.

For many patients adding minimally invasive fat reduction protocols, such as CoolSculpting and Kybella, is a viable option. Both of these fat reduction procedures are used to permanently eliminate submental and submandibular fat for an overall sharper and slimmer jawline. Removing fat around the jawline allows to enhance the results of jawline slimming with Botox by removing the extra fat layer that conceals the angular shape of the angle mandible.

In older patients profound jawline slimming may result in an unwanted jowling, since excess skin secondary to ligamentous laxity tends to shift inferiorly, and worsen the appearance of prejowl sulcus, which characteristically manifests as droopy jowls. Hence, the additional procedure to be consider for improving the appearance of this regionincludes PDO thread lifting to lift droopy jowls. PDO thread lifting works by precise insertion of barbed surgical sutures along the SMAS layer to anchor the overlying sagging skin in a more superior position, creating a lifted effect.

WHAT ARE THE PROS AND CONS OF JAW SLIMMING WITH BOTOX?

  • Pros:
    • Minimally invasive alternative to surgical jaw restructuring
    • Natural looking slimmed down jawline
    • Minimal risks and side effects after injection of the masseters
  • Cons:
    • Serious side effects if injected by unqualified providers
    • Not ideal for patients looking to lift sagging skin along the lower face
    • In older patients may exacerbate jowling by letting the skin to shift more inferiormedially along the mandible

IS BOTOX FOR JAW SLIMMING COVERED BY INSURANCE?

While the medical application of Botox is covered by insurance on a case by case basis, it is not covered if used insofar for aesthetic purposes, such as jaw slimming. Depending on your insurance plan, you may receive coverage if your botox treatment is meant for medical conditions such as TMJ or bruxism.

THINGS TO KEEP IN MIND:

Treating the masseters for both medical and aesthetic objectives is both safe and effective. However, some fundamental factors to keep in mind include the following:

  • Any neurotoxin injected into masseters should always be performed by a board-certified cosmetic physician to forgo the possibility of severe risks and dangerous side effects.
  • Your jaw slimming results will last up to 4 months, so be sure to schedule regular follow-up appointments to maintain them.
  • Not everyone is a candidate for masseter reduction or medical correction using Botox, which is why a consultation with a doctor is crucial to ensure that it is the right treatment option for you.

WHO IS THE BEST DOCTOR FOR MASSETER REDUCTION TO IMPROVE MY JAWLINE IN NYC?

If you are looking to schedule your face slimming Botox, then Skinly Aesthetics on the Upper East Side of Manhattan, New York, NY is the place to be. Owned and operated by Dr. Schwarzburg, a board-certified physician with over a decade of experience, known for his extensive expertise and mastery in minimally invasive cosmetic procedures, Skinly offers top notch services performed exclusively by Dr. Schwarzburg himself. Skinly Aesthetics offers several minimally invasive cosmetic treatments to enhance and define your jawline, alongside an extensive list of body and facial enhancements.

To schedule your one-on-one consultation with Dr. Schwarzburg, you can contact Skinly Aesthetics by calling or texting (212) 774-4264, or email us at info@skinlyaesthetics.com.