Earlier this spring I boarded a plane to Munich for the express purpose of sculpting my cheekbones with one milliliter of hyaluronic acid fillers. Although I originally had no other plans for my short time in town, I realized this was a prime opportunity to add masseter Botox injections to the itinerary. If I was already sitting in the dermatology chair preparing to house a cannula in my face, I was definitely ready for the relatively painless injections that Botox entails.
Let me rewind for a moment to avoid giving off the impression that I run around getting cosmetic treatment and sticking needles in my face. Although the origin story behind my cheek fillers can basically be summed up as “I wanted to try it once,” I had a more concrete and pressing reason for testing out Botox.
Botox has a reputation for targeting wrinkles and fine lines, which makes sense, given that the dermatologists I've spoken to confirm this is the most frequently requested treatment. But it also has other (off-label) applications I've become acquainted with during my years working in the beauty industry. My colleagues seem to particularly love masseter Botox (sometimes referred to as jaw Botox, since the masseter muscle is attached there), a treatment with twofold results. First, depending on your face shape, it can slim your jawline, although the results are much less obvious than cosmetic procedures like Kybella or filler reconstruction. And second—the promise that initially hooked me in—it can prevent you from clenching and grinding your teeth, a skill I could medal in thanks to years of stress.
There are fixes for teeth grinding that don't involve needles; gua sha and face rolling are both options meant to help release tension in your facial muscles, but they are no match for my longtime habit. There are also mouth guards, which dentists love to suggest almost as much as I hate wearing them. When a coworker told me she had created tiny holes in her teeth from consecutive nights of stress grinding ("Wow, same!" I cried) and subsequently fixed the problem in a single Botox session, I leaned in closer. "Tell me everything," I said in awe.
First, it’s important to note that jaw Botox is an off-label use, which means that the FDA hasn’t approved botulinum toxin to be used in this capacity, and there are possible complications you should be aware of. Because the treatment is still fairly new, the medical community hasn’t determined whether it’s safe to use as a longterm treatment. (A 2014 study found that repeated injections of Botox into the muscle near the jaw may cause bone loss and related problems. And the National Institutes of Health is currently still working on a five-year study of the risks.) While many board-certified dermatologists offer the procedure for short-term pain relief, some dentists and maxillofacial surgeons have cautioned overuse.
Armed with that knowledge and after a visit with dermatologist and Royal Fern skin care founder Timm Golueke, I decided it was the best temporary fix for my jaw pain. (Of course, you should always talk to your doctor about what’s right for you.)
How does masseter Botox work?
The procedure as a whole was fairly quick. There are four Botox injections total, two on each side, directed straight into your masseter jaw muscles. You can feel this muscle along the side of your lower jaw when your teeth are clenched; it controls chewing and the raising of your jawbone. But when it’s in a constant state of tension, you may spend many mornings waking up to headaches, jaw pains, and (eventually) Swiss cheese molars, none of which are a particularly good time.
According to Dr. David Shafer, MD, FACS, a double board-certified plastic surgeon and founder of Shafer Clinic Plastic Surgery Fifth Avenue, muscle contractions can be controlled through neurotoxins. “Botox works by decreasing the nerve signals to the muscle,” he says. “For the masseter, this results in decreased bulk of the muscle and a more defined jawline. People can naturally have large masseter muscles or have acquired muscle hypertrophy from chewing gum, grinding their teeth, or other similar reasons." This can cause asymmetry in the jaw.
If you suffer from a clenched jaw or bruxism, you’re an especially good candidate for masseter Botox treatment. “For patients that grind at night or have TMJ (temporomandibular joint), the masseter Botox also has the added benefit of decreasing the strength of the muscle and relaxing the jaw.”
What happens during the procedure?
Golueke instructed me to turn my head to the side and bite down before giving me two quick jabs toward the back of my jaw, and delivering four units of Botox to that side of my face. Each injection lasted perhaps half a second and was over before I could fully react to the sensation of a tiny needle plunging into my skin. We then repeated the process on the other side. I would love to report more details about this procedure, but that was the end of it. There was no swelling, no pain, no need to ice-pack the injection site. Zero downtime. In fact, there was no need to even look in the mirror at this point—because the benefits of masseter Botox would take two weeks to show.
"It’s not filler, which has an immediate effect," says Golueke. "Botox blocks signals from your nerves to the muscle and partly paralyzes the muscle’s strength, which means the function of the muscle itself is reduced. When you’re not able to use it as strongly, clenching is reduced. Additionally, your jaw is not as tense, which changes the visibility of it and creates a slimmer appearance."
What are potential side effects of masseter Botox?
Dr. Shafer stresses the importance of going to an experienced and trained injector, since masseter Botox requires precision and the effects of Botox take time to wear off. “Botox weakens the masseter muscle, so if too much is injected, patients may have a tough time chewing—especially foods like steak or anything requiring a lot of force,” he says. “However, this is unusual. Also, the masseter pulls the jaw up and down for chewing. There are deeper muscles that move the jaw from side to side. If the injector inadvertently injects these deeper muscles, then the patient may have issues moving their jaw from side to side.”
Does masseter Botox really slim your face?
My lower face did indeed appear sharper and slimmer two weeks later, although I credit this partly to the lifting effect of my cheekbone Restylane. As for the permanent tension in my jaw, I sat there grinding my teeth for a week or two until suddenly I woke up one day without the aches and migraines that typically accompany my morning alarm. Since then I’ve noticed that no matter how high my stress levels may be running, I simply physically cannot lapse back into the habit of crushing my jaws together and turning my teeth into enamel shavings.
How much does masseter Botox cost?
Botox is generally administered in units. “For masseter Botox, the starting dose is 20 to 30 units per side,” Shafer says. “Offices range in price from $15 to $30 per unit.”
However, he cautions that all injectors are not the same and to be wary of penny-pinching. “I can't emphasize enough how important it is to go to an experienced and well-trained injector,” he says. “Choosing your injector or office based on price savings never ends well.”
How long does masseter Botox last?
According to Golueke, the results will last "between three to six months, depending on how strong the muscle is and how often you use it."
Shafer says that most patients get their follow-up dose every four months. “It's important to get the next dose before the previous dose is completely gone,” he says.
Sarah Wu is a writer in Berlin. Follow her at @say.wu.
