Ask The Expert: Can Botox cause sagging jowls?

For softening fine lines and wrinkles, Botox is one of the most popular aesthetic treatments in the market. It used to have a bad rep for giving “frozen face”, but today, it has proven effective for alternative uses like relaxing the jaw and helping with teeth grinding or even to ease migraines.

But can overuse of Botox cause sagging jowls? According to Dr. Harvey Ho of Skinscape Clinic, the answer is not so straightforward—and depends largely on skin quality and ageing.

“As we age, we lose volume,” he explains. “Fat decreases, collagen breaks down, and the skin becomes less elastic. All of this naturally leads to sagging.”

Masseter Botox (where the injection site is around the jaw) reduces muscle bulk. In people who already have loose or thinning skin, this reduction in volume may make jowling appear more noticeable.

“Botox itself doesn’t create jowls,” Dr. Ho emphasises. “What creates sagging is skin laxity and age-related volume loss. If your skin quality is good, reducing the masseter won’t suddenly cause sagging.”

Younger individuals with firm, elastic skin are especially unlikely to see sagging as a result of treatment. “A young person doing masseter Botox for years is not going to get saggy jowls just because of that,” he says. “Not until natural aging takes over.”

Botox is commonly sought by people who start noticing expression lines when they smile, frown, or raise their eyebrows. These early signs of ageing usually appear in the late 20s to early 30s. “Wrinkles form when the skin repeatedly folds,” he says. “If you prevent excessive folding, you reduce the chance of developing deeper lines later. That’s why preventive Botox can help.”

If it’s your first time trying Botox, do note that there are plenty of botulinum toxin type A variants on the market. For example, there are brands like Dysport from France, Xeomin from Germany, or Nabota from South Korea and Dr. Ho’s choice in his clinic for as it’s well-regarded for its purity and consistency.

“Nabota has a very predictable diffusion radius,” he says. “It gives me consistent, precise results for both natural and stronger aesthetic effects.”

Effects typically last three to four months, though some patients request touch-ups at two months, something which Dr. Ho generally discourages as early top-ups may affect long-term effectiveness. “If you inject too often, there’s a small chance the body may develop antibodies,” he explains. “That can lead to resistance over time.”

In general, botulinum toxin type A treatments have no down-time, but there are several things you should take note of in the first 24 hours: no exercise, no excessive heat (e.g. saunas, steam rooms, hot yoga or facial steaming) and no movement that might encourage the Botox to migrate. Think: massage, cupping or acupuncture on treated areas. “Facials can usually be done after a few days. Gua sha should be avoided for 24 hours to a few days too,” he advises.

Skinscape Clinic is located at 8 Marina View, #02-07 Asia Square Tower 1, Singapore 018960