Botulinum toxin (Botox®)
I am 35 years old and I had to have Botox® injections following masseter muscle hypertrophy that appeared at the end of 2013, but the results obtained are not convincing.
I would like to know if it is possible to undergo a surgery to fix this problem in order for me to get my real face back.
Masseter muscle hypertrophy is often associated with bruxism. Therefore, the chewing muscles are hyperactive, which leads to muscular enlargement in the same way the volume of your biceps will increase if you lift weights.
Injecting botulinum toxin type A in the masseter muscles is a recent medical application in the treatment of bruxism and the reduction of the volume of the masseter muscles. Dr James Mah presented an interesting webinar on this subject to the members of the Canadian Association of Orthodontists on November 18. The title was Neuromodulators in the management of bruxism.
He quoted several studies, such as the one conducted by Chikhani L. and Dichamp J., that confirms the efficiency of Botox® in the treatment of bruxism in the ⅔ (two thirds) of patients. The study included 1150 patients. There were no side effects of diffusion to the superficial facial muscles, which means that the smile did not seem stiff. Usually, 3 to 4 treatments are necessary.
The possible complications are pain or discomfort to the injection sites. This is a little understandable, it is never pleasant to get an injection.
There are possibly surgical solutions, but the type of your face would have to be determined. I suspect that you have a rather short and square-shaped face. If this is the case, an orthosurgery treatment to lengthen the maxilla could be considered. I recommend you to consult a certified orthodontist.
Chikhani L1, Dichamp J. [Bruxism, temporo-mandibular dysfunction and botulinum toxin]. [Article in French] Ann Readapt Med Phys. 2003 Jul;46(6):333-7.