What is Botulinum Toxin (Botox)?

Botulinum toxin is obtained from a bacterium called “Clostridium botulinum”. In other words, it is not snake venom as it is mentioned among the people. This substance partially blocks the nerve impulses to the target organ and creates a temporary and reversible paralysis in the target area.

For what purposes is Botox used?

It’s used cosmetically in the treatment of superficial / medium and deep wrinkles, for eyebrow lifting, in cases where there is excessive sweating in areas such as armpits / hands / feet (hyperhidrosis), excessive teeth clenching and masseter hypertrophy, in cases where the gums appear more than normal when talking or laughing (gummy smile) and in the treatment of chronic migraine. In addition to these, it is also indicated in spasticity, cerebral palsy, spasmodic torticollis, blepharospasm, hemifacial spasm, cervical dystonia, and bladder spasm.


What is the need for the treatment of clenching problem and masseter hypertrophy?

The masseter muscle is one of the muscle groups located in the lateral region of the jaw (under and behind the cheeks) and is important for chewing function. This muscle group can be structurally large. In addition, if it works harder than it should be due to excessive use (too much chewing gum, etc.) or stress, discomfort such as jaw clenching, teeth grinding, toothache will occur. At the same time, if this muscle grows too much, the appearance of the jaw line changes, and a more angular, square-shaped chin appears instead of an oval. Botox is applied to this area in order to both functionally correct the clenching problems and to soften and ovalize the jaw line, giving it a more aesthetic appearance.


How does Botox application work in case of excessive clenching and masseter hypertrophy?

Botox application temporarily paralyzes some of the nerves going to the masseter muscle. In this way, the masseter muscle is prevented from working more than it should.


How to apply Botox for teeth clenching problem?

There is no need for operating room conditions for this procedure. It is one of the applications that can be done easily in office conditions where sterility principles are taken into account. Injections are made into the target muscle (masseter muscle) with the help of very small needles. The process takes an average of 10 minutes. After the procedure, you can return to your daily life.


When does the effect start after Botox application for the treatment of clenching problem and masseter hypertrophy?

The effect of the application begins after 1-2 weeks. The maximum effect is felt in 4-6 weeks.


How long does the effect of Botox application for the treatment of clenching problem and masseter hypertrophy last, what are the factors affecting the permanence?

The effect of botulinum toxin made for this purpose lasts for an average of 6 months. The duration of botulinum toxin application varies according to the individual factors. Age, smoking, nutrition and personal reasons are among the most important of these variable factors. There may be situations where the effect is not as long and effective as expected. In this case, the development of resistance is investigated, dose adjustments are made, or other subtypes of botulinum toxin can be applied. It should be noted that results may vary from person to person. If you have been treated with botulinum toxin too often before, or if the dose was too high, your body may start to produce certain substances called antibodies to the botulinum toxin, and these substances can reduce the effect of the newly injected botulinum toxin.


How often should this application be repeated?

Repetitive applications prolong the duration of action. It is thought that 3 applications, especially 3 months apart, permanently reduce teeth clenching problems and masseter hypertrophy. The interval between two botulinum toxin treatments should not be shorter than 3 months.


What should be considered after Botox application?

In order to prevent the unwanted spread of botulinum toxin on the day of application, the application areas should not be massaged, and the swelling should not be tried to be distributed. Activities such as hammam, sauna and heavy exercise are not recommended on the application day. In the first hours after the application, activities that force your jaw excessively (excessive gum chewing, chewing rigid foods) should be avoided. You can return to your routine life the day after the application.


Is Botox application painful?

Since the injection needles used are quite small, the pain is minimal. Patients describe the situation with expressions such as “as much as a mosquito bite”. Local anesthetic injection is not recommended before the procedure, as it will affect the distribution of Botox. Since the target muscle is under the skin, topical creams applied to the skin do not work. After the procedure, the pain in the injection sites will pass in a very short time.


Will there be bruising after Botox application?

Rarely, small bruises may occur due to damage to the small vessels in the application area. This does not change the effect and result of botulinum toxin treatment. After the procedure, it is recommended to apply ice to the bruised area without massaging and pressing hard. If a bruise occurs, it will go away in 3-4 days, and the use of foundation during this time will mask the bruise.


Is there any chewing problem after Botox application?

The masseter muscle is a powerful muscle that is very important in chewing function. In line with the complaints, some weakening of the muscle does not cause a problem in its function.


What are the other procedures that can be combined with Botox application for the chin area?

If the discomfort is a square or angular face appearance caused by masseter hypertrophy rather than a clenching problem, the individual should be carefully analyzed. The causes of fullness in the cheek area are variable. While this appearance is caused by excess cheek fat (buccal fat pads) in the anterior section, the masseter muscle is more effective on the appearance in the posterior region of the chin. These two situations should be analyzed well and if needed, a combination of bichectomy should be considered for a thinner, sharper, more attractive and more aesthetic facial structure (See Bichectomy (Buccal Fat Removal) Section).


What are the other problems encountered after Botox application?

Botox application to this area may rarely cause smile problems and asymmetry of the corner of the mouth, depending on anatomical variations and structural factors. This situation is temporary. Very rarely, an allergic reaction may develop after botulinum toxin injection. If you experience difficulty in breathing, swallowing or speaking or if you experience hives, swelling (including swelling of the face and throat), wheezing, fainting, and shortness of breath after the injection, contact your doctor or nearest healthcare facility immediately, as these are possible signs of a severe allergic reaction.


Who is Botox not applied to?

Botox injection is not applied in the presence of active infection in the area where the injections are planned, in neurological or neuromuscular diseases (Motor neuropathies, ALS, Myasthenia Gravis, Eaton-Lambert Syndrome…), in drug use such as aminoglycosides (gentamicin…) and curare-like non-depolarizing blockers, in case of lactose and albumin allergy, during pregnancy and breastfeeding.


Botulinum toxin (Botox) injections are simple and highly effective applications that are frequently used in the treatment of clenching problems and masseter hypertrophy. An application of about 10 minutes provides serious relief in clenching. The duration of the botulinum toxin application varies according to the previous applications, the treated area, and the individual factors. Please do not compare the application with other applications and yourself with other people. The possibility of complications increases after overdose application and unfortunately it is not reversible. Instead, I prefer to have the effect I want with the least possible dose, and I do my applications accordingly. There are two possibilities after the first application. Either the dose applied will be sufficient and no additional dose will be needed, or the effect will be seen, but you will need a little more. If we need a little more dosage, we will take care of it in your control visit. Like I said, it’s much safer to underdose and do extra doses if needed, than to overdose. Medical aesthetic applications such as botulinum toxin application should be applied by doctors who have both theoretical and practical knowledge and experience in skin and subcutaneous anatomy, have a deep knowledge of the subject, can manage the complications and are experts in their field. Best regards.