Why Is Satisfaction with Masseter Botulinum Toxin So High on Dcard?
When I browse Dcard for idle reading, I notice that "a slimmer face" is always a hot topic.
If you dig through Dcard posts, you will find that on the topic of a slimmer face, there are truly a hundred schools of thought.
Some recommend face-slimming exercises, masseter massage, or even "jaw bone shaving" (that's a bit too much trouble…)
In fact, for many Taiwanese a square face is not due to square bones like Koreans that need bone shaving. Rather, Taiwan has so much good food, and we love chewing jerky, tapioca pearls, taro balls…, which leaves two parts of the masseter especially well developed.
People with a particularly well-developed masseter usually need close to 80U of masseter botulinum toxin for the effect to be more noticeable.
Many people don't know that after spending just five minutes on masseter botulinum toxin, the facial contour clearly slims. The cases below are all results of a single 80U masseter botulinum toxin session.
So once safe and effective masseter botulinum toxin appeared, it quickly became one of the popular solutions for a slimmer face.
The masseter gets smaller with continued top-ups, and the top-up dose can become lower and lower. My client (pictured below) originally had a masseter thickness of 2 cm (standard value 1 cm). After the first 80U of masseter botulinum toxin, the thickness at the three-month follow-up became 1.3 cm. He had a 60U top-up, and afterwards regular top-ups every six months were about 40–50U.
Whatever brand of botulinum toxin is used, the effect lasts roughly half a year, and without continued top-ups, it returns to the "factory setting" after about a year.
A Super Simple Table for Masseter Botulinum Toxin
| Masseter botulinum toxin | Shoulder botulinum toxin | Calf botulinum toxin | |
|---|---|---|---|
| Target muscle | Masseter | Upper trapezius | Gastrocnemius |
| First-session dose | 40–80 U, both sides | 120–200 U, both sides | 200–400 U, both sides |
| Time to take effect | 3–4 weeks | 3–4 weeks | 3–4 weeks |
| Cost (calculated with Korean botulinum toxin) | NT$4,500–8,000 | NT$10,000–15,000 | NT$15,000–25,000 |
What happens after the injection — the timeline at a glance:
| When | What happens |
|---|---|
| At the injection | Finished in about 5 minutes, with only a sore feeling |
| First 1–2 days | The muscle feels sore (the volume feeling of saline), gone after 3 days |
| 4 weeks | Starts to take effect (large muscle groups are naturally slower than forehead lines, so don't worry) |
| 12 weeks | The masseter reaches its smallest |
| About 6 months | The effect gradually fades; a top-up can be considered |
| Single session, no top-up | Starts to recover at about 9 months, and returns to the factory setting at about a year |
Does Masseter Botulinum Toxin Hurt? Why Do Some People on Dcard Say It's Very Painful?
Masseter botulinum toxin is about the most entry-level aesthetic treatment, hurts less than skin-booster injections, and is over quickly in about five minutes.
With botulinum toxin for forehead lines, frown lines and crow's feet, because there are many nerves in the forehead area, a noticeable pain is sometimes unavoidable.
Masseter botulinum toxin only feels sore at the moment of injection. In addition, I use the thinnest invisible needle currently available (34G sharp needle) together with ice packs, so the injection process is almost painless.
How Is Masseter Botulinum Toxin Injected Precisely with Ultrasound?
Why do some people get poor results after masseter injection? Some people truly have a square face from bone structure, or a naturally larger face from a baby face. If the masseter is not well developed, no amount of botulinum toxin will help.
So to judge precisely whether a client is really suited to masseter injection, before injecting we always take an ultrasound to confirm your masseter thickness. Some people turn out to have only fat and no muscle; they don't need to waste money on botulinum toxin, and what they need more is ultrasound fat reduction.
When scanning a client's masseter by ultrasound, you can clearly see, about 1 cm below the skin, a masseter about 0.8–1.5 cm thick.
(ref_doi: 10.1007/s11282-019-00383-4)
The white line beneath the masseter is the mandible (the line the white arrow points to). Masseter botulinum toxin must be injected at both deep and superficial levels; otherwise, if the deep masseter receives botulinum toxin but the superficial part does not, the face will develop "frog cheeks".
With ultrasound, compared with feeling by hand, I can better see how each client's masseter composition differs.
Because every person's masseter shape varies somewhat, ultrasound not only makes the injection position more precise but can also accurately calculate the depth of the masseter, so I can adjust how deep the needle goes.
Injecting the masseter with botulinum toxin under ultrasound guidance allows a different design for different clients, and also gives clients more peace of mind.
How Should Masseter Botulinum Toxin Be Injected to Avoid Hollow Cheeks?
First, we have to find the masseter.
Clients may think: "Isn't the masseter easy? I can feel it myself, can't I?"
Oh, thinking that way is dangerous.
During injection, the masseter can only be injected in the lower part of the muscle to be effectively reduced, which is the three areas IV, V and VI in the figure below.
The upper part of the masseter, the three areas I, II and III in the figure, is very close to the cheekbone. If masseter botulinum toxin is injected there, the area below the cheekbone easily looks sunken — the familiar "hollow cheeks"!
This is also why I often see people complaining about hollow cheeks after botulinum toxin. If the injection position is wrong, instead of reducing the masseter as intended, the hollowing of the cheeks may even become worse!
Ultrasound Is a Great Tool for Tracking Masseter Reduction
If a client returns 3 months after masseter botulinum toxin, you can see that before the injection the muscle tissue looked sparse and dark (because the muscle bundles were all fluffy).
Three months after the injection, the muscle bundles have shrunk, so under ultrasound they look denser, and the thickness of the masseter has clearly decreased.
Where Do the Dcard "Tragedy" Posts About Botulinum Toxin Masseter Reduction Come From?
1. Botulinum toxin accidentally injected into the risorius on the surface of the masseter → crooked smile
When injecting masseter botulinum toxin, we are very afraid of hitting the risorius (on the surface of the masseter), so a longer needle must be used!
I have seen a clinic use an extremely short insulin needle to inject masseter botulinum toxin, and I truly broke into a cold sweat for them! Not only can it not reach the muscle, with much of the dose wasted, it is also more likely to be inaccurate and hit the superficial risorius.
2. Botulinum toxin reaches only the deep masseter but not the superficial part → frog cheeks
The masseter is actually divided into deep and superficial layers!
The superficial layer is what relates to appearance and a slimmer face; the deep layer can hardly be felt and is mainly responsible for chewing. So the masseter everyone can feel is actually the superficial layer!
If a doctor at an aesthetic clinic keeps inserting the botulinum toxin straight into the deep masseter, but the superficial masseter receives none, the superficial masseter will instead become more prominent, taking the shape of "frog cheeks".
If frog cheeks do happen by accident, there is no need to worry too much: botulinum toxin lasts at most half a year, and after it is naturally metabolised the frog cheeks slowly return to normal.
3. Botulinum toxin accidentally injected into the zygomaticus major on the inner side of the masseter → crooked face
At a talk by Dr. Chuang Te-Yang, he shared one case in which an entertainer went to an underground studio at a non-aesthetic clinic for botulinum toxin, and the zygomaticus major was accidentally injected, causing half-face paralysis…
4. Botulinum toxin injected too high → hollow face
There are two situations in which the cheeks become hollow after botulinum toxin. One is a doctor's error in injecting the wrong position, so that cheeks that were not hollow become hollow.
The other is that the cheeks were already hollow, and after the injection the hollowing looks more obvious.
So with this type of client I always state beforehand that after masseter botulinum toxin the hollow cheeks will look more obvious, since the protruding muscle shrinks as well.
It is usually recommended to fill the hollow cheeks with hyaluronic acid together with masseter botulinum toxin, so the face shape looks smoother.
Of course, if you unfortunately encounter any of the above botulinum toxin failures, at least don't worry too much: botulinum toxin lasts at most half a year, and after some time, once it is naturally metabolised, the side effects slowly return to normal.
How Long After Botulinum Toxin Does the Masseter Reduction Show?
The direct answer: masseter botulinum toxin starts to take effect at about 4 weeks and reaches its smallest at 12 weeks, and the effect of a single session is estimated to last about 9 months.
The masseter starts to take effect at around 4 weeks!
Based on my clinic's experience and a recent paper, the masseter can reach its smallest after 12 weeks.
If only one session is given, with no second or third dose at all, it is estimated to last about 9 months.
But most clients return to their original enlarged masseter by 1 year.
However, the latest study shows that with 3 consecutive botulinum toxin A injections, 6 months apart, an average 12% reduction in masseter volume was maintained 1 year after treatment.
Therefore, this injection regimen offers a longer-lasting masseter atrophy effect.
None of the participants reported any adverse reactions or complications, such as infection, facial muscle paralysis, facial asymmetry, hollowing of the cheekbones or cheeks, paradoxical bulging, or disappearance of the dimple.
What to Watch for After Masseter Botulinum Toxin?
First, after botulinum toxin in a large muscle group, you will feel sore for the first 1–2 days, because a fair volume of saline is injected into the muscle.
But since saline is naturally absorbed by the body, you won't feel much after 3 days!
In addition, botulinum toxin in large muscle groups (masseter, shoulders, calves) is very different from botulinum toxin in small muscle groups such as forehead lines and frown lines.
Forehead lines and frown lines, being small muscle groups, usually take effect in about 7 days.
But botulinum toxin in large muscle groups usually takes 4 weeks to take effect. So if you don't clearly feel any masseter reduction after 1 week, that is completely normal.
Please keep waiting patiently until after 4 weeks, when the botulinum toxin gradually starts to work!
Masseter Botulinum Toxin FAQ
How many units of masseter botulinum toxin?
The first session is usually 40–80U in total for both sides. People with a well-developed masseter usually need close to 80U for a more noticeable effect, and later top-ups decrease (60U → 40–50U). The actual dose is based on the muscle thickness measured by ultrasound before injection, not a guess from how big the face looks.
How much does one session of masseter botulinum toxin cost?
Calculated with Korean botulinum toxin, about NT$4,500–8,000, depending on the dose.
Does masseter botulinum toxin hurt?
It is entry-level for aesthetic treatments and does not hurt. With the thinnest 34G invisible needle and ice packs, there is only a sore feeling at the moment of injection, and it finishes in about 5 minutes.
How soon does it work? How long does the effect last?
It starts to work at 4 weeks and reaches its smallest at 12 weeks. A single session lasts about 9 months; studies show that with 3 consecutive injections, once every 6 months, an average 12% reduction in masseter volume was maintained 1 year after treatment.
Why do some people get frog cheeks or hollow cheeks after the injection?
Frog cheeks happen when only the deep layer is injected and the superficial layer is not; hollow cheeks happen when the injection is too high (the area near the cheekbone) or the cheeks were already hollow. Both relate to the injection position, and choosing a doctor who uses ultrasound for positioning can greatly reduce the risk. Even if it does happen, botulinum toxin is naturally metabolised within half a year at most, and the side effects slowly return to normal.
Is everyone suited to masseter botulinum toxin?
No. For some people, ultrasound shows that the face is large because of fat, not muscle — for them botulinum toxin is a waste of money, and what should be considered is a fat-reduction treatment.
What to watch for after the injection?
Muscle soreness in the first 1–2 days is normal (the volume feeling of saline) and disappears after 3 days. Don't worry if you feel nothing after 1 week; large muscle groups naturally take 4 weeks to take effect.
