The masseter is the primary chewing muscle, located at the angle of the jaw. In patients with masseter hypertrophy — overdevelopment of this muscle — the lower face takes on a wide, square appearance that many patients find disproportionate and masculine-looking. Botulinum toxin injected into the masseter causes gradual atrophy of the muscle, slimming the lower face over several months. It is one of the most consistently requested facial botulinum toxin treatments at our clinic, and one of the most satisfying for patients who are appropriate candidates.

Who Has Masseter Hypertrophy

Masseter hypertrophy can be bilateral or asymmetrical, and has several causes: habitual teeth grinding (bruxism), jaw clenching (particularly stress-related), a heavy chewing diet (hard foods, gum chewing), and genetic factors. Many patients have a combination. Bruxism-associated masseter hypertrophy is often accompanied by jaw pain, headaches, and dental wear — and botulinum toxin treatment addresses both the cosmetic concern and the functional symptoms simultaneously.

The Treatment

Treatment involves injecting 20-30 units of botulinum toxin per side into the masseter muscle bulk at the jaw angle — doses vary significantly between patients depending on muscle size. The injections are quick and well-tolerated. Results develop gradually over 4-8 weeks as the muscle progressively atrophies. The full slimming effect is visible at 2-3 months. Duration is typically 4-6 months initially; with repeated treatment over time, the results tend to last longer as the muscle undergoes progressive reduction and patients often require less product at subsequent sessions.

Important Considerations

Masseter reduction should not be performed in patients with significant dental malocclusion or temporomandibular joint dysfunction without appropriate specialist assessment. And the degree of slimming is proportional to the degree of hypertrophy — patients with a naturally slim jaw and minimal masseter bulk will see limited change, as there is little muscle to reduce. A proper pre-treatment assessment of masseter size is essential before proceeding.

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— Dr. Nishita Ranka | Consultant Dermatologist | Dr. Nishita’s Clinic for Skin, Hair & Aesthetics, Hyderabad