Cosmetic patients with masseteric or parotid and submandibular hypertrophy are often wide across the mid to lower face and appear to have a square-looking faces. Correction of the hypertrophy in which the width of the face is at least partially attributable to the wide hypertrophic masseter muscle or hypertrophic glands will result in a more oval, or round, faces.
“Masseter muscle reduction is a procedure often requested by Asian ethnicities and more commonly in the Korean population. The surgical techniques employed to reduce masseter and parotid and submandibular glandular hypertrophy can be brutal and can be associated with sometimes severe complications and a long recovery period,” says Michael Kane, M.D., plastic surgeon and associate attending surgeon, Manhattan Eye, Ear and Throat Hospital, New York. “The use of botulinum toxin can effectively treat the hypertrophy and circumvent unwanted surgical trauma and complications.”
Upon examination, patients will bite down and the physician palpates for and localizes the masseter hypertrophy. While holding the anterior and posterior aspects of the masseter muscle, the surgeon injects botulinum toxin into the protruding muscle bulk. Though many different injection techniques have been postulated — including four- or five-point injection patterns such as that on a die — Dr. Kane says masseter hypertrophy can vary from patient to patient, so one should inject the toxin only where the hypertrophy is felt and not in a predetermined injection pattern.