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Masseter Muscle Hypertrophy in relation to squaring of the lower face and TMJ pain in West Palm Beach Gardens, Florida


All you need to know about Masseter Muscle Hypertrophyin relation to squaring of the lower face and TMJ pain in the West Palm Beach Gardens, Florida

Hypertrophy or enlargement of the masseter muscle can lead to squaring of the lower face. This enlargement is undesirable aesthetically, especially for females. Hypertrophied masseter muscles can be a genetic condition or a parafunctional condition as Bruxism which is teeth grinding.

The good news is that this condition can be treated with a simple injection of Botulinum toxin A as Botox, Xeomin, Dysport, or Jeaveaux. The prominent mandibular angle area is generally not accepted as aesthetically pleasing by female patients, who perceive these characteristics as masculine.

Although beauty ideals may vary for different ethnicities and cultures, the desire for a soft oval or heart-shaped face with a slimmer and well-defined jawline is a common request in aesthetic clinics. The goal in aesthetics, especially for females, is to widen the upper face creating prominent cheeks and cheeks bones. Also, to thin the lower face by minimizing the masseter muscle hypertrophy in the West Palm Beach Gardens, Florida.

Masseter Hypertrophy differs among different races. It is more severe in Asian patients requiring a higher and more frequent dose to correct the problem.

Squaring the lower face can negatively impact self-esteem. If coexisting with conditions such as Bruxism in the West Palm Beach Gardens, Florida, can lead to long-term alterations in functions and symptoms such as orofacial pain, headaches, and dental issues.

Stress, anxiety, and personality type can also affect the severity of masseter hypertrophy.

Botulinum Toxin A (BoTN-A) has been safely and efficiently indicated for masseter hypertrophy and Bruxism using BoTN-A. Trade names of which are mentioned earlier.

Masseter Muscle
The masseter muscle (MM) is one of the four muscles of mastication and the most powerful. MM acts thru the temporomandibular joint(TMJ). This is why injecting the MM also helps with TMJ pain in the West Palm Beach Gardens, Florida.

The MM is quadrangular in shape and composed of overlapping layers.
The overlapping area is the bulky and palpable area, noticeable when patients clench their teeth, and it is located inferiorly near the jawline.
The MM has a significant clinical significance as it is the core of masseteric hypertrophy and Bruxism in the West Palm Beach Gardens, Florida. It is closely related to facial aesthetics because it contributes to lower facial contouring.

Masseteric Hypertrophy
First described by Legg in 1880, masseteric hypertrophy (MH) is a rare entity and can present as either unilateral or bilateral benign enlargement of the masseter muscles. There is no gender prevalence, and patients are generally in their 20s to 40s.

The condition’s etiology is unknown and is not always linked to parafunctional conditions such as Bruxism or teeth grinding. It can be related to masseteric hyperfunction by abnormal habits such as chewing gum, diet, and hard food [4].
When related to Bruxism, MH can be accompanied by temporomandibular joint pain.
Although benign and usually asymptomatic, it can adversely impact patients’ lives due to potential disfigurement. It often involves enlargement and bulging at the mandibular angle region, producing a ‘square face,’ notably if associated with asymmetry.

Bruxism or teeth grinding in the West Palm Beach Gardens, Florida
In 2013, an international expert group defined Bruxism as “repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and bracing or thrusting the mandible. “

The prevalence of Bruxism differs broadly in the literature, affecting 6-91% of the adult population and no significant differences regarding gender. So, it is a common condition.

Other important factors that also play a role are psychosocial such as stress, anxiety, personality type, and pathophysiological such as genetics, smoking, heavy intake of alcohol and caffeine, illicit drugs (i.e., cocaine and ecstasy), and certain medications (e.g., selective serotonin reuptake inhibitor).

BoTN-A is a neurotoxin with a well-defined mechanism of action; at the neuromuscular junction, blocking the release of acetylcholine from motor nerves and inhibiting muscular contractions.
BoTN-A is a safe and effective treatment for people suffering from severe Bruxism, reducing muscular activity.
Muscle atrophy may be advantageous for bruxism patients and those aiming for cosmetic contouring of the lower face.

The goal of the treatment is to achieve patient satisfaction. Therefore, an effective reduction in muscle volume and activity must be accompanied by relief of symptoms (in Bruxism) with a smooth, symmetrical, and balanced contouring of the lower face without inconvenient side effects.

Potential complications are usually temporary and self-limiting.

Complications include :

  • Non-muscular: bruising, hematoma, dizziness, and headache.
  • Toxin effect related: chewing weakness and pain. This should improve within a week.
  • Dose/level related: poor or no effect, asymmetry, jowling, sagging, paradoxical bulging.
  • Injection site related: asymmetric smile, sunken lateral cheeks, and difficulty in mouth opening.
  • It is essential to mention here that complications are less frequent with an experienced injector.
  • Also, an experienced injector can realize and manage these complications more successfully.

Literature shows effectiveness from using 20-30 units of Onabotulinum toxin on each side in Western patients to 40-60 units in Asian patients on each side. It is equally pertinent to select the best location for the toxin injections to prevent complications.

This ‘safety zone’ can be located by palpating the MM and knowing the critical anatomical neighboring structures.

Lower Face

This figure schematically shows where the masseter muscle is injected.
Then ask the patient to clench again. I mark three to four points, 1cm apart. The injection points may form a triangular (three injections) or quadrangular shape (four injections). This may differ depending on the bulk and width of the MM, together with variable dosage also.
The injection plane is deep, perpendicular, and in contact with bone. Therefore a 13mm needle is recommended instead of the 8mm needles more commonly used for BoTN-A for wrinkles injections.


This photo shows before and after the Masseter muscle injection in the West Palm Beach Gardens, Florida. It shows how thinning the lower face gives an aesthetically pleasing shape. The whole face looks more V or heart shape. It is way more feminine and beautiful as well.

Results are gradually noticed, with facial changes shown as early as two weeks after injections. Statistically, significant differences peaked at three months post-treatment and decreased at six months follow-up.

With results being of a temporary nature, a return to normal function is expected at some point, bearing in mind that the effect of muscular atrophy is secondary to relaxation. Therefore awareness of this longevity is relevant as it will dictate the need for booster injections.

The end goal of any aesthetic treatment should be to achieve balance and harmony. Therefore treatment of masseter hypertrophy should be tailored, and in conjunction with a thorough assessment of the other facial areas, this is valid for both genders.
Dr. Dahabra is an excellent Masseter muscle injector in the West Palm Beach Gardens, Florida, area.

Call (561) 318-5367 to book your treatment and see the results for yourself.

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