The other day, one of my best friends told me she wanted to get Botox injections in her jaw. She just accepted a new job offer and wanted to "treat herself" to bilateral jaw-muscle Botox, a procedure she's been contemplating for the past two years (specifically during the pandemic).
We're both in our mid-twenties living in New York City, so we run with people who have started getting injections, most commonly Botox in the forehead and a few cases of lip filler. However, jaw-muscle-specific injections — sometimes called 'TMJ' Botox, or Botox of the masseter (chewing) muscles — is a bit niche.
While less common than forehead or frown-line Botox, jaw-muscle injections are nothing new. For people who've been diagnosed with TMJ (temporomandibular joint disorder), masseter Botox is commonly recommended by a dentist or orthodontist as a way to relieve tension and alleviate symptoms of chronic teeth grinding, jaw clenching, even migraine headaches. However, NYC plastic surgeon Dr. Melissa Doft says that she's recently observed a notable increase in clients booking in for cosmetic masseter Botox, which she says, speaks to a larger trend in jawline interventions.
"There's a huge interest in the jawline, increasing definition in the jawline," Dr. Doft tells me. (We've seen this anecdotally on TikTok, with people using highlighter to enhance the jawline.) In her practice, Dr. Doft often treats patients with submental liposuction and chin augmentation to permanently alter the angle or shape of the jawline. Though, she notes that "non-invasive" procedures, like masseter Botox, have become increasingly popular. "There's been a dramatic increase in interest among a young population," Dr. Doft says.
So, what are masseter muscles?
Masseter muscles are our muscles of mastication, or chewing. If you feel where your jawline hinges on either side of your skull, there's a right angle. "If you bite down, you can see and feel the prominence or bulge there — that's the muscle," Dr. Doft explains. If you have TMJ, you might have other symptoms that relate to your masseter muscles. Robert Merrill, DDS, clinical professor and residency director for oral facial pain at the UCLA School of Dentistry tells R29: "This would include some jaw muscle tenderness, clicking, or other noises during jaw movement and joint tenderness," he says.
How do the masseter muscles become enlarged?
Teeth grinding and jaw clenching are the big culprits. "Grinding your teeth can actually change the shape of your jawline," Dr. Doft explains. "Given the amount of stress that people are under with Covid, we're seeing that way more often." Though Dr. Doft also adds that there's a genetic component as well: "Some people are born with larger masseter muscles. But with any muscle growth, it's the activity — exercising the muscle — that's making the muscle grow larger."
How does this impact the jawline?
Think about enlarged masseter muscles like swollen lymph nodes; other people might not notice anything 'off' in the shape of your jaw, but you may be able to see and feel it. Ginille Brown, a L.A.-based cosmetic nurse practitioner, says that many of her jawline-Botox clients note that they have a "squareness" to their jawline that they're looking to narrow. Dr. Doft also notes a comment on the perceived bulkiness of the jaw. "For most people, they want the angle to be smaller, more delicate, a little bit less bulky. So, that's where Botox can help slim that jaw area."
How does masseter Botox work?
Masseter Botox is not all that different from Botox injections in the forehead or 11s. "With Botox, you're blocking the nerves transmission of information to a muscle, so the muscle can no longer squeeze," Dr. Doft explains. The Botulinum toxin is injected via a syringe, directly under the ear, where the jaw hinges. "I usually do three small injections on each side, starting with 25 units per side," says Dr. Doft. "If it's not enough, we can increase it, but that's a safe starting point."
Important note: When injected properly — this should always be done by a licensed professional plastic surgeon, dermatologist, or nurse practitioner — masseter Botox does not impact your ability to use your jaw. You can talk, smile, chew, as usual. "There are several muscles that are used to control chewing," Dr. Doft assures. "The Botox just helps to decrease the [teeth] grinding, and many people notice it helps with jaw pain or TMJ, too. Cosmetically, you can see a slimming of the jawline, which is sometimes pretty significant."
Though, for the noticeable slimming effect, Brown explains that it's not like you get an injection and your jawline is snatched. "Patients often find that tension relief is pretty immediate, especially if they're in pain, but the decrease in masseter muscle size takes time," Brown explains. "The muscle will eventually get smaller over time as it's not being activated. But it's not like you get Botox on a Friday night and you're seeing a change for the weekend."
How much does it cost?
As for cost, that's slightly variable, depending on where you live and who you're seeing.In New York City, you'll be looking at anywhere between $600-$1,000 (£440-730) a session. "For the masseter muscles, we charge $1,000 to do the both of them," says Dr. Doft, adding that in her experience, the longevity is similar to facial Botox. "I usually inject patients two or three times a year," she adds.
The good news? After a few rounds of Botox, most people can wean off. "If you stop exercising the muscle, it's going to atrophy or shrink. It's the same thing with doing Botox on the face: Over time, sometimes people can get less Botox, less often because those [jaw] muscles are not being worked by facial expression."
Are there other interventions that I should try before Botox?
If you're hesitant to get Botox, Dr. Doft recommends trying a mouthguard, if you haven't already. "If you're grinding your teeth, a lot of dentists recommend dental blocks, like a mouthguard, so the teeth aren't rubbing against each other as much," she says. Another option: a skin-tightening facial. "We've also been doing a lot of microneedling with radio frequency to tighten the neck and jawline. It's an anti-aging technique, but we also have a lot of young patients who are interested in it because it improves the tone and texture of the skin, and also causes a little tightening around the jawline."
According to Brown, most of her clients looking for jawline or TMJ Botox have already tried the more accessible interventions, with no real results. "My patients have already tried everything else," she explains. "They've tried the mouth guards, pain relievers, acupuncture, massage, relaxation techniques — and it's just not cutting it."