Contouring of the lower face and the masseter muscle: a minimally invasive solution with botulinum for a more feminine face

 

 

Aesthetic medicine has evolved steadily to meet patients' individual needs with regard to improving their physical appearance. A particular challenge is the treatment of patients with hypertrophic masseter muscles, which can cause a square lower face that is perceived as masculine. Injecting neurotoxins into the masseter muscles offers an effective method of achieving a more feminine facial contour. This article is aimed at healthcare professionals and examines the clinical considerations and procedures for this treatment.

 

Fundamentals of masseter hypertrophy and aesthetic correction

Hypertrophy of the masseter muscles can lead to a visually pronounced lower third of the face, which is often associated with a masculine facial shape. The use of botulinum toxin (BTX) to selectively weaken these muscles enables non-invasive contouring of the lower face in order to restore a more harmonious, more feminine facial shape.

 

Clinical considerations

Before treatment, it is essential to inform the patient comprehensively about the temporary nature of the neurotoxin effect. Typically, the masseter muscles return to their previous state within 1 to 2 months after the neurotoxin activity has worn off, which makes regular repeat treatments necessary. Furthermore, practitioners should inform the patient about the potential weakening of masticatory force and possible changes in occlusion that may occur during the initial phase after injection.

 

Injection technique

Correct localisation of the injection sites is crucial for the safety and effectiveness of the treatment. By palpation, 2 to 3 areas of maximum contraction of the masseter are identified, and the injection points should always remain below an imaginary line from the tragus to the lateral lip commissure in order to prevent unintended spread of the toxin to the risorius muscle and resulting undesirable effects on the patient's smile. The recommended dose varies between 25 and 45 units (Botox) per side, depending on the individual degree of hypertrophy and the patient's aesthetic goals.

Fig. (A) Schematic illustration of the masseter muscle. (B) Injection sites. (C) Before and after injections into the masseter muscle in hypertrophy.

 

 

Summary

Treatment of masseter hypertrophy with neurotoxin is an effective strategy for achieving an aesthetically desirable, more feminine contour of the lower face. Careful patient selection, thorough patient education and precise execution of the injection technique are crucial to the success of the therapy. Practitioners should be aware of the temporary nature of the treatment and inform patients of the need for regular repeat treatments.

 

Source: Fisher. Atlas Oral Maxillofac Surg Clin North Am . 2024 Mar;32(1):7-14. doi: 10.1016/j.cxom.2023.09.004. Epub 2023 Oct 28.