LAM FACIAL PLASTICS

Hi Dr. Lam,

I am a 24-year-old Asian female who received the maximum dose of Botox to my jaw 3 months ago. As a result, my cheeks have become sunken in. The results of the Botox was drastic. From frontal view, my face is much slimmer and oval shaped, which I am happy with. However, in the 45 degree and side view, my cheeks have become visibly sunken in, making me look unhealthy. I am already a skinny girl to begin with (5'4 and 100 pounds) so perhaps there is a lack of fat on my face which contributes to the sunken cheek look. I also do not have prominent cheekbones which may contribute the sunken cheek look.

Is this a common side effect of Botox jaw reduction? How long will it be before the Botox wears off and my cheeks become full again? I am happy with what the Botox has done to my jawline, but not my cheeks. If I decide to receive Botox injections again in the future, is it possible for me to focus mainly on slimming my jaw without affecting my cheeks?

to further illustrate, here are some before/after pictures i've attached. i hope what i am trying to depict is clear even though the pictures are cropped

this is interesting, as i have never seen this outcome. what your doctor most likely did is a variant of the technique i use that is rather popular, specifically to inject upward along the mandible (jawbone)'s masseter muscle. that is most likely what has affected your cheek. i only inject the bottom edge of the masseter muscle so i have never seen this outcome higher. in any case, don't worry, this should be a temporary outcome and should come back over the next few months. typically, the only negative of botox of the jawline is how long it lasts (usually a good thing). it may last 6 to 9 months in most cases with a slight return starting to show at 6 months. hope that helps. obviously, you should ask your doc about what is going on. that would be the preferred way to go since i have no idea what he did to inject the area.
best,
sml

Thanks for the prompt response Dr. Lam. When I google images of the masseter muscle, I can see that the muscle extends from the jaw to the cheekbone. When I bite down, I can feel the muscle underneath my cheekbone. Therefore, it seems to make sense how atrophy of the muscle can cause the cheeks to sink in along with the narrowing of the jaw. However, since you have not seen this happen before, I wonder if there was something that my doctor had done wrong. As I'd mentioned, I asked for the maximum dose, and he'd injected it near my jawline, not my cheeks. My surgeon is a very prominent one on the West coast who should have a lot of experience in doing these injections.

Anyway, my question are:
1. Do you think my surgeon has made a mistake in injecting the botox which led to the sunken cheeks? If this is a normal result for me, I probably will not do the injection again as having sunken cheeks is not a worthwhile trade off to a slimmer jaw. If I decide to do more injections in the future, is it possible to focus only on reducing the lower muscle? Perhaps the dosage was too high, or I do not have enough fat on my cheeks?
2. Is there anything I can do to speed up the process of making my cheeks full again? Preferably, just strengthening the muscles around the cheeks and not the jaw. I got the in injection in September and the results are still very dramatic.

Once again, thank you so much for the help. You are a really awesome doctor for creating a forum like this.

1. Do you think my surgeon has made a mistake in injecting the botox which led to the sunken cheeks? If so, I probably will not do another injection. I really like what the botox has done to my lower jaw, and I'd like to know if it's possible to focus only on reducing the lower muscle in the future. Perhaps the dosage was too high, or I do not have enough fat on my cheeks?
PERHAPS I HAVE OVERSTEPPED MY BOUNDS HERE. THERE IS NEVER 100% PREDICTIVE CAPACITY ON ANYONE'S WORK, NOT EVEN MINE. I REALLY THINK YOU SHOULD ASK YOUR SURGEON/PHYSICIAN HIS OR HER THOUGHTS. I WOULD LIKE TO REFRAIN FROM FURTHER COMMENTARY REGARDING HIS/HER WORK. IT IS NOT FAIR SINCE I WAS NOT THERE.
2. Is there anything I can do to speed up the process of making my cheeks full again? Preferably, just strengthening the muscles around the cheeks and not the jaw. I got the in injection in September and the results are still very dramatic.
PROBABLY NOT IN MY OPINION. PATIENCE. THE ONLY THING I COULD THINK WOULD BE TO INJECT SOME RESTYLANE IN YOUR OUTER CHEEK TO BULK IT UP TEMPORARILY THEN DISSOLVE THE RESTYLANE WHEN THE MUSCLE MASS RETURNS. THAT WOULD BE THE SAFEST OPTION. HOWEVER, IT WOULD REQUIRE MORE COST, ANOTHER PROCEDURE, AND IT MIGHT NOT ADDRESS THE ISSUE TO YOUR SATISFACTION. OBVIOUSLY, WHATEVER AESTHETIC OUTCOME, I DON'T THINK YOU HAVE A DEFORMITY SO PERHAPS PATIENCE IS THE MOST ECONOMICAL AND SENSIBLE ROUTE TO UNDERTAKE. TRY TO FOCUS YOUR MIND ELSEWHERE. YOUR FOCUS ON THE CURRENT ISSUE (WHICH SHOULD BE TEMPORARY) WILL ONLY COMPOUND YOUR NEGATIVE FEELINGS TOWARD IT. ANY FURTHER QUESTIONS SHOULD BE DIRECTED AT YOUR PHYSICIAN SO THAT HE/SHE CAN HELP YOU, WHICH IS MORE APPROPRIATE THAN A PHYSICIAN HALFWAY ACROSS THE CONTINENT WHO HAS NEVER SEEN OR TREATED YOU TRYING TO HELP YOU. AS YOU KNOW, I LOVE ANSWERING QUESTIONS AND HELPING PEOPLE. I JUST DON'T KNOW IN THIS SITUATION IF I AM DOING THE GREATEST GOOD FOR YOU.
BEST,
SML