Speaker 1: Welcome to Plastic Surgery Talk with Dr. Stephen Mulholland, brought to you by SpaMedica.
Dr. Mulholland: So what is bruxism? Bruxism is a medical term for those people, patients, who tend to grind at night. They’re grinders, they’re clenchers, and every night, they’re grinding and grinding, and as a result of that impact, that force of clenching your jawline muscle back here called the masseter, you get flapping of the dental occlusal surfaces and chronic bruxism can lead to aesthetic deformity, or we call it alteration, strong jawline, which is not terribly feminine. And it can actually lead to temporomandibular jaw pain or impact crushing and pressure and force on the joint that opens your jaw, the temporomandibular joint and TMJ pain. So grinding at night can lead to grinding, and smoothing, and sanding down of occlusal surfaces and effect your occlusion, it can lead to chronic pain and headaches and spasms of the jaw and muscle, temporomandibular joint pain, and to an aesthetic enlargement of the lower jaw, which may be okay if you’re [inaudible 00:01:08] and you’re a football player and a guy, but it’s not particularly feminine if you happen to be a woman.
So what are the treatments for bruxism and nocturnal grinding? The first is to often see your dentist about the occlusal surfaces, and if they notice that you’re a bit of a grinder and you have a thick jaw, maybe long before you have TMJ pain or masseteric [inaudible 00:01:30] or muscle overgrowth and they’ll give you a nocturnal sled. A nocturnal sled will protect the grinding so it will save your dental surfaces, the occlusal surfaces. But it won’t stop the ongoing [inaudible 00:01:40] jaw, or the impact force on your temporomandibular joint. So it will help with the dental [inaudible 00:01:47] that comes with grinding, but not the enlarged masseter or the temporomandibular joint. So as you move up in the option, the next and most effective is the least invasive option is Botox into the masseter.
Just like we can use Botox to relax muscles that over frown or over squint, we can inject into the masseter and put that masseter muscle to sleep for six, nine months which gives tremendous amount of relief on the dental grinding. It relieves the pain and spasm of this masseter overload and hypertrophy and can actually give almost immediate relief of temporomandibular joint pain. So Botox, masseteric Botox, is probably the best, least invasive, longest lasting treatment for bruxism.
Dr. Mulholland: Who’s a candidate for Botox into masseteric hypertrophy? Will anyone who suffers from bruxism and nocturnal grinding, those that want to save or preserve their occlusal surfaces and not wear a nocturnal sled to be on this long before the sled and do Botox? For those that suffer from aesthetic strong jaw syndrome where you have a very square jaw and happen to be feminine and want a more oval. And then those that have headaches, muscle spasm pain or temporomandibular joint or TMJ pain. Those are all good candidates for masseteric Botox.
Speaker 1: Who is not a candidate for masseteric Botox? What’s the contraindication? Those patients that are contraindicated for Botox. If you have an autoimmune disorder, like Lupus or Scleroderma or MS or ALS, you might be declined treatment. Though that’s a relative contraindication. Pregnancy, you can’t be pregnant and undergo Botox treatment. If you have an anaphylactic reaction proven to neuromodulator before, that would be a contraindication to treatment.
So very few absolute contraindications. Generally Botox is very safe and very effective. Almost all patients without those more extreme medical conditions are going to be a good candidate for Botox for bruxism. How effective is Botox for masseteric hypertrophy? Well, in short, very effective. So what does it do? We inject the Botox in the right proportion with a very small syringe. The treatment is very easy, very simple to do. Often I’ll use the laughing gas or nitrous oxide to take the edge off. They’re very, very comfortable. One our of ten to two out of ten have discomfort.
The Botox is placed right into the muscle, the clenching muscle itself. It doesn’t work immediately. It takes a few days to uncouple the contraction apparatus from the signal to clench. Your brain goes clench, clench, clench, but you can’t release the chemical that causes the muscle to contract. So the relaxation happens over about a week. Then you start to see some relief from the pain because there’s no more spasm. You’re not clenching, so you’re not grinding. It relieves the temporomandibular joint pain within a week. You’re not getting migraines or headaches or spasm within a week. So it’s effective usually within a week, fully effective within two weeks.
The longevity of that pain and symptom relief will be up to a year. What about the aesthetic improvement? The aesthetic improvement happens because that strong square jaw, that guy jaw that women don’t want, takes time. It takes time for the muscle not to contract and then wither away. So the withering way takes often three or four weeks. I tell most women you’re going to be quite happy with the shape within six weeks. That shape improvement, that square shape to a more feminine, oval or anime shape to the face, well that [inaudible 00:05:21] a year. How quickly can you return to activities of normal living and daily living including work and social interactions?
The answer is immediately. It’s very, very unusual to get bruising, noticeable swelling after a masseteric Botox. Unlike lip augmentation or under eye fillers where bruising is very common, there’s virtually very close to zero risk of [inaudible 00:05:45] bruising in that or some complication that may mitigate your ability to go back to work. So it’s truly one of those things that you can do over lunch time. Are there any [inaudible 00:05:54] or adverse events and side effects following masseteric Botox? In reality, the side effect profile is very, very safe. I’ve been doing masseteric Botox for a couple of decades. And if you look at the literature in my personal experience, I have not had a single serious complication or side effect.
There are some mild side effects that you notice. For example, you can’t chew as strongly. And that sounds great if you’re a grinder, a nocturnal bruxor. However, if you have a big filet mignon and a steak, you want to chew it. You really have to work at it because you’ve lost your prime grinding muscle, your clenching muscle. So one side effect is it’s harder to chew chewy foods. So you may move towards soups and pastas and softer foods because chewing down on very gristly foods, vegetable matter is much more difficult.
But most women are happy with the aesthetic outcomes though with that side effect. Sometimes one muscle is more relaxed than the other, you can come back for a little touch up. That’s uncommon. Rarely, and this goes down to the skill of the injector, the deep injection hits the wrong muscle and [inaudible 00:07:02] your smile and something may happen that’s [inaudible 00:07:06]. In my practice, that doesn’t happen because I know where I’m injecting, but it can happen and it is important to be cautious as to who you select as your injector, but very safe to do masseteric Botox and very effective for it’s treatment goals. So there’s masseteric Botox doesn’t work with any other treatments.
So there are complementary treatments that give you a better result. Most of the women I see may have bruxism, they may have dental grinding, they may have TMJ pain, but they want to look better. So they want to shrink the masseter and make it look more oval. Quite often, I’m combining masseteric Botox with fillers in the upper cheek to give that cheek sweep. We take a boxy face and do this with fillers along the zygomatic arch, masseteric Botox, maybe a little filler support in the corner of the mouth. Botox to the corner of the mouth, Botox brow lifting and maybe some energy based treatment. Fractional technologies, tiny technologies to tighten the skin and improve color. The big three are Botox, filler and energy based devices complementing a return to more oval, youthful look.
Is there any maintenance with masseteric Botox and what is the nature of that maintenance and how long does it take? The masseteric component of your rejuvinational lasts upwards of a year. Generally, you shrink down your clenching jaw masseteric muscle once a year to keep that oval shape. The other components are your multi-modal treatment with the energy based treatment, the Botox for your brow and other areas, you have to do twice a year. But for the masseteric component, once a year. Generally it’s going to take about 45 to 60 units per side if you’ve got a very big masseter. And from 25 to 30 units if you have a modest masseter. So you have to look at pricing for your masseter hypertrophy in the Botox treatment to be somewhere between 30 and 120 units, depending on how many units you need to control that masseter.
The number one risk is under botoxing and thinking it doesn’t work on me. So some people may only use 15 or 20 units and their masseter needs 45 or 60 units. It’s not that it didn’t work, it’s that they didn’t use enough. Make sure you go to an experience clinic where the physician or physician delegate has experience and use enough to put your masseter to sleep. Then you have to do it once a year to maintain that beautiful result. What is the cost for masseteric Botox? It depends on your masseter and how much Botox is required. On average, 45 units and 45 units would be the most common amount of Botox needed for a large masseteric overgrow and that would be 90 units. The doctor pricing typically costs North Americans around $10 per unit. So it’s about a thousand dollars to shape your masseter for one year.
If you combine that with the energy based treatments, like photo facials, fractional, [inaudible 00:09:59] and Botox elsewhere, you usually pay less the more you do. But just masseteric Botox, in general would be about a thousand dollars average cost. Some clinics might be 800, some might be upwards of 1500, 1600. It depends on the physician. You might need 60 units in each masseter and that’s 120 units. That might cost you more. So that will be the average range per unit as stressed in the masseteric Botox treatment. Generally affordable. An fordable treatment cost for the huge benefit, facial shape, TMJ pain, muscle spasm, migraines and dental occlusion. So thank you for joining me. Dr. Stephen Mulholland here in Toronto, Canada on plastic surgery talk. For our latest installment of our podcast series, this one on Botox for masseteric hypertrophy or the treatment of bruxism. A very specialized use for Botox, but a very valuable and potentially life changing for patients. Again, if you found this interesting, education and entertaining, please share this, subscribe and comment. See you next time.