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Botox
Is it true masseter muscle botox for jawline will create sagging from loss of volume?
Theoretically, yes, Botox can atrophy the masseter muscle, which decreases bulk/volume at the angle of the mandible, reducing support for the more distal tissues. The degree to which this happens is variable. I do caution my more mature patients regarding this possibility, especially if they have very prominent jowls but yours are very mild. Also, if your goal is functional (to reduce the clenching/grinding), you do not have to use a high number of units to fully relax the muscle. Lastly, the results will be temporary so if it does happen that you get worsening sag of the distal tissues, the Botox will eventually wear off and you can regain some muscle bulk by chewing gum.
Clinical Context
The masseter is a chewing muscle at the back of the jaw. When Botox relaxes it, the muscle can shrink over repeated treatments, which is why some patients see a slimmer jawline. In people who already have looser skin or sagging jowls, that same shrinkage can occasionally make the sagging look more noticeable, since the muscle was providing some underlying support. This effect varies from person to person and reverses as the Botox wears off and muscle bulk returns.
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