My cheeks became hollow after getting jaw Botox—why did that happen?

My cheeks looked hollow after jaw Botox—why did that happen?

These days, the weather changes several times a day,

and fine dust is back with a vengeance.

Japan really is remarkably clean.

It almost feels like our country is

filtering all the fine dust for everyone, haha.

At times like this, I feel it's more important than ever to
carefully think through any procedure before getting it done.
Today, I'd like to start with a question I hear all the time in the clinic.

"Ever since I got jaw Botox, my cheeks seem to have really sunken in."

When people first hear this,
many assume it's just weight loss, or maybe they're imagining it.
But after seeing quite a few cases,
I can say with confidence that this is not just an illusion.

💡 Key summary of today's post

Q. Why do cheeks look hollow after jaw Botox?
A. As the masseter shrinks, the support structure around the outer cheek changes along with it.

Q. Does cheek hollowing mean the procedure was done incorrectly?
A. Not necessarily. It tends to be more pronounced in people who naturally have less cheek volume.

Q. How can it be addressed once cheek hollowing occurs?
A. Volume can be supplemented with fillers or lifting procedures—I'll cover this in detail below.

Why jaw Botox can cause cheek hollowing

Jaw Botox, or masseter muscle Botox,
involves injecting botulinum toxin into the masseter—the muscle responsible for chewing—
to reduce its volume.

Its primary purpose is to soften a square jaw or slim the lower facial contour,
and because the results are quite visible,
it's a procedure many people seek out.

But there's one important point to keep in mind.
The masseter isn't simply a muscle attached alongside bone—
it also plays a role in the support structure of the mid-to-lower cheek.

When the masseter decreases in size, the overlying
buccal fat layer and skin
can gradually settle downward or appear somewhat hollow.

What makes this tricky is that
while the jawline clearly becomes slimmer,
the cheeks can start to look older in a way that's hard to pinpoint.

A study on masseter volume reduction and surrounding soft tissue changes (PubMed)also reports that
repeated Botox in patients with masseter hypertrophy
may be accompanied by positional shifts in the buccal fat layer.

Who is more likely to develop cheek hollowing?

To be honest,
the larger the masseter and the lower the natural cheek volume,the more likely cheek hollowing is to occur.

In my experience, the following patients require extra caution:

Those with severe masseter hypertrophy and naturally little cheek fat
Those in their mid-30s or older with already reduced skin elasticity
Those with low body fat or an overall lean build
Those who have had repeated masseter Botox resulting in significant muscle atrophy

On the other hand, if you're in your early-to-mid 20s with fuller cheeks and good skin elasticity,
cheek hollowing tends to be relatively less noticeable
even as the masseter reduces.

I was mistaken about this at first, too.
Initially, I thought there would be no problem as long as I targeted the masseter well,
but as I accumulated more cases, I came to realize that assessing cheek volume first
is actually the more critical step.

If you're concerned about hollowing,
placing the injections slightly lower on the masseter may help reduce that risk.

If the hollowing is already more pronounced,

collagen boosters such as Juvelook or Sculptra

can also be a good option.

👨‍⚕️ Director Wi Youngjin's practical note:

In my experience, the majority of cheek hollowing complaints
stem from cases where cheek volume was not adequately assessed during the pre-procedure consultation.

When consulting for masseter Botox, I always
evaluate cheek fat-layer thickness and skin elasticity first.
For patients with severe masseter hypertrophy and low cheek volume,
I make a point of explaining upfront that
"while the jawline will slim down, the cheeks may appear more hollow."

It's an unfortunate trade-off, but
precisely because jaw Botox delivers such clear results,
failing to account for overall facial volume changes
can backfire and actually make you look older.
One thing I always stress:
the higher the volume and speed of a clinic's caseload, the more likely this consultation step is to be skipped.

If cheek hollowing has already occurred, what should you do?

For those who already have cheek hollowing, my approach generally falls into two categories.

Cheek filler correction:Restoring volume in hollow areas with hyaluronic acid filler. Results are immediate, and when done with a natural touch, the improvement looks seamless.
Combining with lifting procedures:Thread lifting or HIFU-based treatments to lift tissue that has drooped below the cheeks may also be worth considering. That said, the right choice varies by individual case.

One more thing to add:
stopping masseter Botox right away is not necessarily the solution.
Once the Botox effect wears off, the masseter can redevelop to some degree,
which may allow for some cheek recovery,
but in some cases, a significantly atrophied masseter does not fully return to its previous state.

The more realistic path to resolving cheek hollowing is not simply stopping masseter Botox, but rather taking steps to appropriately restore cheek volume.

Key takeaway:Cheek hollowing after jaw Botox results from changes in the cheek's support structure caused by masseter reduction. Pre-procedure assessment is especially essential for those with naturally low cheek volume.

Jaw Botox: what to check before getting it

To prevent cheek hollowing, make sure the following points are addressed during your pre-procedure consultation.

Whether your cheek volume is sufficient (i.e., whether the fat layer is thin)
Skin elasticity (extra caution is warranted if you are in your 30s or older)
How many times you have previously had masseter Botox
Whether your goal is square-jaw reduction specifically, or overall jawline improvement

It varies by case, but
for patients with insufficient cheek volume, I typically recommend
either reducing the masseter Botox dose
or doing cheek filler first and then proceeding with Botox.

This is something many people misunderstand:
more jaw Botox is not always better.
The higher the dose, the more the masseter shrinks,
and the greater the risk of cheek hollowing.

Director Wi Youngjin covers this point thoroughly
at every consultation.
Rather than simply saying "I'll reduce your masseter,"
approaching treatment based on the overall facial structure
leads to much higher patient satisfaction.

Frequently Asked Questions

Q1. If I stop masseter Botox, will the cheek hollowing go back to normal?

A. Once the Botox effect wears off, the masseter does redevelop to some extent. However, in cases where repeated treatments have caused significant atrophy, it may not fully return to its previous state. If cheek hollowing is bothering you, considering cheek filler correction rather than simply stopping treatment is often the more practical approach.

Q2. Is there a way to reduce a square jaw without causing cheek hollowing?

A. Dose adjustment is the most important factor. Using an appropriate amount based on the degree of masseter hypertrophy and your cheek volume can slim the jawline while minimizing hollowing. For those with low cheek volume, doing filler first and then proceeding with masseter Botox is another viable option.

Q3. If cheek hollowing occurs, how much filler will I need?

A. This depends on your individual condition, and it's difficult for me to give specific numbers without seeing you in person. The approach varies depending on the location, depth, and skin condition around the hollowing, so an in-person consultation is the necessary first step. You're also welcome to send photos via KakaoTalk before your visit.

If you have any questions, feel free to reach out on KakaoTalk.
You're welcome to ask before coming in.
This has been Dr. Wi Youngjin.

✦ Read together

My cheeks looked hollow after jaw Botox—why did that happen?

These days, the weather changes several times a day,

and fine dust is back with a vengeance.

Japan really is remarkably clean.

It almost feels like our country is

filtering all the fine dust for everyone, haha.

At times like this, I feel it's more important than ever to
carefully think through any procedure before getting it done.
Today, I'd like to start with a question I hear all the time in the clinic.

"Ever since I got jaw Botox, my cheeks seem to have really sunken in."

When people first hear this,
many assume it's just weight loss, or maybe they're imagining it.
But after seeing quite a few cases,
I can say with confidence that this is not just an illusion.

💡 Key summary of today's post

Q. Why do cheeks look hollow after jaw Botox?
A. As the masseter shrinks, the support structure around the outer cheek changes along with it.

Q. Does cheek hollowing mean the procedure was done incorrectly?
A. Not necessarily. It tends to be more pronounced in people who naturally have less cheek volume.

Q. How can it be addressed once cheek hollowing occurs?
A. Volume can be supplemented with fillers or lifting procedures—I'll cover this in detail below.

Why jaw Botox can cause cheek hollowing

Jaw Botox, or masseter muscle Botox,
involves injecting botulinum toxin into the masseter—the muscle responsible for chewing—
to reduce its volume.

Its primary purpose is to soften a square jaw or slim the lower facial contour,
and because the results are quite visible,
it's a procedure many people seek out.

But there's one important point to keep in mind.
The masseter isn't simply a muscle attached alongside bone—
it also plays a role in the support structure of the mid-to-lower cheek.

When the masseter decreases in size, the overlying
buccal fat layer and skin
can gradually settle downward or appear somewhat hollow.

What makes this tricky is that
while the jawline clearly becomes slimmer,
the cheeks can start to look older in a way that's hard to pinpoint.

A study on masseter volume reduction and surrounding soft tissue changes (PubMed)also reports that
repeated Botox in patients with masseter hypertrophy
may be accompanied by positional shifts in the buccal fat layer.

Who is more likely to develop cheek hollowing?

To be honest,
the larger the masseter and the lower the natural cheek volume,the more likely cheek hollowing is to occur.

In my experience, the following patients require extra caution:

Those with severe masseter hypertrophy and naturally little cheek fat
Those in their mid-30s or older with already reduced skin elasticity
Those with low body fat or an overall lean build
Those who have had repeated masseter Botox resulting in significant muscle atrophy

On the other hand, if you're in your early-to-mid 20s with fuller cheeks and good skin elasticity,
cheek hollowing tends to be relatively less noticeable
even as the masseter reduces.

I was mistaken about this at first, too.
Initially, I thought there would be no problem as long as I targeted the masseter well,
but as I accumulated more cases, I came to realize that assessing cheek volume first
is actually the more critical step.

If you're concerned about hollowing,
placing the injections slightly lower on the masseter may help reduce that risk.

If the hollowing is already more pronounced,

collagen boosters such as Juvelook or Sculptra

can also be a good option.

👨‍⚕️ Director Wi Youngjin's practical note:

In my experience, the majority of cheek hollowing complaints
stem from cases where cheek volume was not adequately assessed during the pre-procedure consultation.

When consulting for masseter Botox, I always
evaluate cheek fat-layer thickness and skin elasticity first.
For patients with severe masseter hypertrophy and low cheek volume,
I make a point of explaining upfront that
"while the jawline will slim down, the cheeks may appear more hollow."

It's an unfortunate trade-off, but
precisely because jaw Botox delivers such clear results,
failing to account for overall facial volume changes
can backfire and actually make you look older.
One thing I always stress:
the higher the volume and speed of a clinic's caseload, the more likely this consultation step is to be skipped.

If cheek hollowing has already occurred, what should you do?

For those who already have cheek hollowing, my approach generally falls into two categories.

Cheek filler correction:Restoring volume in hollow areas with hyaluronic acid filler. Results are immediate, and when done with a natural touch, the improvement looks seamless.
Combining with lifting procedures:Thread lifting or HIFU-based treatments to lift tissue that has drooped below the cheeks may also be worth considering. That said, the right choice varies by individual case.

One more thing to add:
stopping masseter Botox right away is not necessarily the solution.
Once the Botox effect wears off, the masseter can redevelop to some degree,
which may allow for some cheek recovery,
but in some cases, a significantly atrophied masseter does not fully return to its previous state.

The more realistic path to resolving cheek hollowing is not simply stopping masseter Botox, but rather taking steps to appropriately restore cheek volume.

Key takeaway:Cheek hollowing after jaw Botox results from changes in the cheek's support structure caused by masseter reduction. Pre-procedure assessment is especially essential for those with naturally low cheek volume.

Jaw Botox: what to check before getting it

To prevent cheek hollowing, make sure the following points are addressed during your pre-procedure consultation.

Whether your cheek volume is sufficient (i.e., whether the fat layer is thin)
Skin elasticity (extra caution is warranted if you are in your 30s or older)
How many times you have previously had masseter Botox
Whether your goal is square-jaw reduction specifically, or overall jawline improvement

It varies by case, but
for patients with insufficient cheek volume, I typically recommend
either reducing the masseter Botox dose
or doing cheek filler first and then proceeding with Botox.

This is something many people misunderstand:
more jaw Botox is not always better.
The higher the dose, the more the masseter shrinks,
and the greater the risk of cheek hollowing.

Director Wi Youngjin covers this point thoroughly
at every consultation.
Rather than simply saying "I'll reduce your masseter,"
approaching treatment based on the overall facial structure
leads to much higher patient satisfaction.

Frequently Asked Questions

Q1. If I stop masseter Botox, will the cheek hollowing go back to normal?

A. Once the Botox effect wears off, the masseter does redevelop to some extent. However, in cases where repeated treatments have caused significant atrophy, it may not fully return to its previous state. If cheek hollowing is bothering you, considering cheek filler correction rather than simply stopping treatment is often the more practical approach.

Q2. Is there a way to reduce a square jaw without causing cheek hollowing?

A. Dose adjustment is the most important factor. Using an appropriate amount based on the degree of masseter hypertrophy and your cheek volume can slim the jawline while minimizing hollowing. For those with low cheek volume, doing filler first and then proceeding with masseter Botox is another viable option.

Q3. If cheek hollowing occurs, how much filler will I need?

A. This depends on your individual condition, and it's difficult for me to give specific numbers without seeing you in person. The approach varies depending on the location, depth, and skin condition around the hollowing, so an in-person consultation is the necessary first step. You're also welcome to send photos via KakaoTalk before your visit.

If you have any questions, feel free to reach out on KakaoTalk.
You're welcome to ask before coming in.
This has been Dr. Wi Youngjin.

✦ Read together