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Today’s podcast is on Botox jaw reduction, it is a technique that I use almost every single day to help people cosmetically have their lower face look slimmer, a less wide, more balanced as well as functionally to help with grinding. One of my friend broke one of his teeth and was in so much pain that I injected the Botox the next day and basically eliminated all his pain within a few hours. The way that I do it is incredibly precise. It is important. It is not so difficult to inject it. It is more important to know where to inject it. So we first have to understand, before we talk about techniques and some of the goals in doing this. So look cosmetically, if someone has a pretty large jowl, I don’t inject the outer face because sometimes the jaw looks bigger in relative proportion, but if someone is younger or just has a wide face, it makes someone look a lot more youthful and less heavy.

Now, how does it make someone look yet less youthful? Because when we’re in our forties, 50s, and sixties, the lower face starts to dominate in width and it makes someone look older because that area is wide, either from weight gain or gravity or jaws or whatever it may be. That lower face starts become a dominant area. And if you think you can widen the upper face to match the lower face, you simply cannot, the definition of the face or the relative shape of the phase is defined by the lower face, not the upper face. So yes, I put fillers in temples all the time. I do widen the upper face, but to get the facial shape better, if it’s too wide, lower down, it really requires Botox of the lower face. So that’s really the key thing to improve the facial shape.

It takes about six weeks to see the difference, although occasionally you can see results within one to two weeks. I tell patients six weeks just to give them enough time to observe the improvement. In terms of the functional issues, if they’re grinding or clenching, they may need to do Botox too. And obviously if they have both issues, it’s far better that, you know, they have both issues, then you get killed two birds with one stone. The next part is the technique. And what I tell my patients is that I actually spend more time marking the patient out than actually injecting it because you really have to be very precise. There’s a lot of things I’m going to define for you that defines safety and precision in terms of a result. So we’re the masseter muscle inserts into the bone there three points and that area is what I target because it’s the area that causes the maximal width to the face. Also is the area that gets the most effective reduction. I use 25 units per side and some of the Korean studies have shown much higher units, can also cause long term atrophy in an unfavorable way. The distribution is so important as well. So I usually do a five point injection and really distribute it in a way for maximal impact. The way that I do it is virtually painless if you’ve had it elsewhere. Most patients are quite surprised that my injections don’t hurt at all. However, I will say that, if one of the measurements for me to define how if you grind, let’s say you have a wide face and you don’t even know if you grind, if I inject it and you have no pain whatsoever, not even feel the needle go in, then that is you most likely don’t grind.

But if you say, well, my left side was a little bit sore than the right side is because your muscle was inflamed. That’s why the Botox injected there actually can help with that condition and tells me as a feedback loop in the future, if you have less pain after I’ve injected it, that means the second or third time that as actually working. A natural question then is how often do I need to inject Botox in the masseter the jaw? The answer is really depending on a few factors. About 5% of my patients have such a strong muscle. They have to come back at three months for another treatment for the first round. But thereafter it’s less often. I usually, I tell my patients if they like to follow up with me at six weeks just to take photographs and answer any questions, that’d be great.

Otherwise, I usually see them back at six months for the next treatment. If they’re a heavy grinder or clencher, they probably need several rounds performed every six months to get long term outcomes where they oftentimes can go to nine months to a year. For those that are just have a naturally wider lower face that don’t grind, I wind up Botox them at six months, then I can usually go to a nine month interval and oftentimes to a year or even longer after the third interval. So it’s actually quite beneficial long term for my patients to maintain their facial shape, uh, without the cost expenditure of needing to come in. Very often for vast majority of my patients and as I alluded to, even those patients that grind typically don’t need to come in as often after a few rounds. Now, just this week I had a lady that I was getting her to about once a year, but then I just saw her a year later she had really very massive jaws again.

And I think the reason for her, even though she was being maintained at once a year, is her habit of grinding got really bad again. And so it just flared up and she looked worse. Some of the risks of the procedure and that’s why anatomy is so important in terms of the injection is that I don’t inject above the trachea is the ear cartilage that when you press a, in the middle of your ear through the ear canal is what blocks the sound if you’re trying to close off sound. So you don’t want to go above the trachea. Also you don’t want to go too low along the jaw line and that minimizes snagging a facial nerve that could cause some issues that makes you look like a stroke. So that’s very, very important.

The other thing is you want to stay about a centimeter behind the anterior border of the masseter muscle because there is a muscle that comes out called the risorius that can affect the smile. And I will tell you once a year, and I inject every day, I get one patient with a temporary risorious paresis that goes away in about four to six weeks. It’s something that, I had one lady, I was quite upset about this, but it does go away in four to six weeks, but it’s something that can occur, but it’s not that common. The other thing that can happen in rare cases is a bulge where when someone grinds the bulge can be visible. That’s probably one out of a hundred as well. If I see that I just put little Botox in there and then it goes away.

I usually don’t charge for that touch-up. But usually if you are out of town or worried about that, most of that time, most of it just regresses within four to six weeks anyways. A very small percentage of my patients for about a week, they can have a little bit of tiredness or fatigue when they chew. So Botox jaw reduction must be done by someone who does it all the time. That’s very, very focused on the anatomy and hopefully this council will give you a better idea of how I do it and why I do it, and some of the pros and cons and limitations of the treatment.