Chin – A strong chin will enhance and assist the oval shape. In the absence of a strong chin we use dermal fillers such as Juvederm Voluma or Radiesse to support and create an adequate chin.
Cheek Bones and Mid Face – High, strong and wide cheek bones will support the mid face and keep the ideal width of the upper face required to achieve and maintain the oval shape. We use Juvederm Voluma to the cheeks and mid face while providing botulinum toxin to the masseter at the same visit. Supporting the mid face will also support any hollowing that maybe present in the tear trough region.
Temples – often neglected but critical for a youthful upper face, are full wide temples. Temples can also be filled with a myriad of Fillers such as Radiesse and Juvederm Voluma. Most candidates for facial reshaping tending to be younger, will generally have an appropriately full temple area not needing the addition of fillers.
Masseter Reduction
Younger than Older – Younger faces are more likely to the benefit from masseter reduction without the risks of sagging of the lower and mid/central face. Mature clients are more likely to develop some sagging of the skin along the jawline and jowls but this will contract back up over the following months. For the latter reasons we also advice that mature clients proceed with masseter reduction at lower dose over the first year, to allow time for the skin to recover and contract over the jawline.
An Important question we consider in facial reshaping is if the wider lower face is due to true Masseter Hypertrophy. The culprit could be a large buccal fad pad, a wide jaw angle, or simply widening of the lower face due to sagging, or all three factors could be the issue. Age related widening or sagging of the lower face is not a prescription for botulinum toxin to the area. Removal of the buccal fat pads is known to be a relatively easy procedure but reduction of the jaw angle or “ reduction gonioplasty” is a complex surgical procedure.
How Much Botox Is Needed to Treat an Enlarged Masseter?
After considering the above mentioned candidacy requirements we will carefully inspect for masseter symmetry. In general, starting doses can vary from 25 to 30 units of Botulinum toxin per masseter at the first visit. Five to eight spaced out injections are done to each masseter. In cases of significant asymmetry the larger masseter will be injected with an additional 5-10 units of botulinum toxin.
Follow Up Treatments
Follow up treatments in the following weeks and months are key as we assess for residual muscle movement and bulk of the masseter. Treatments maybe given at 6 weeks and 12 weeks following initial treatment of the masseter. Some clients may gain their ideal masseter reduction or facial shape following 2 to 3 treatments, but rarely does one treatment maintain any bulk reduction and lead to long term changes. If clients are satisfied with the result after the first one or two sessions, we advice the maintenance phase of treatment which is about 25 to 30 units per side every 4 to 6 months.
For Masseter Reduction, we see our clients an average 2- 3 times the first year, then about 1-2 times the following year.
Do I Have To Keep Doing Botox Every Year?
To maintain your new slim jawline, you may have to continue to receive Botox for up to 2 years. What we have found is after 2 years of consistent injections of Botox into the Masseter, we see longer lasting results to the Masseter.
