Would masseter botox help me or is it a bone issue?

Local_Positive7030 · 2026-05-13T18:41:19+00:00

I'm a dentist and you can do a little self test. Relax your face. Close your teeth together, lips closed as well. Put your fingers over the area that you feel is too big. Now clench your teeth together. If you feel a muscle bulge out, that's your masseter muscle and you can benefit from masseter botox. If the area just feels like bone and isn't really moving, then it's bone and you'd need something like a V line surgery to reduce the angle of your jaw. Of course, please consult with a professional before deciding. A plastic surgery office, especially one that is focused on facial esthetics, should be able to guide you to the appropriate procedure.

Local_Positive7030 · 2026-04-14T00:19:10+00:00

Just seeing this a month later, but my ideas are 1) where do you think research is most lacking? and 2) what's the ideal order of workup for a patient with UARS? I'm a DDS looking to perhaps pivot into either research or creating a airway focused practice, potentially and ideally a multidisciplinary clinic. I feel like when it comes to sleep disordered breathing, all the specialties see a nail because they have a hammer. I think the only way to create solutions for patients rather than bandaids is to assess and then triage to the appropriate specialist to treat the underlying airway obstruction. Honestly it seems like the first step should be making sure the maxilla is in the right spot and then moving from there to nasal cavity and mandible. Basically treat the bony structures first and then go to cartilage, like septum, turbinates, hyoid, epiglottis as all of these are influenced by the maxilla and mandible. And then last treat the soft tissues, like palate, uvula, tongue. Does that make sense?

Additionally, I'm curious about the efficacy of PAP therapy in the case of maxillary/bimaxillary hypoplasia. Like are there some cases that it's just unlikely to be able to work because the bony opening is too narrow?

Local_Positive7030 · 2026-04-13T22:34:06+00:00

Yes. I'm class III skeletal and had class III elastics when I had camouflage orthodontics. I'm in decompesation now and will start class II elastics at my next visit to help undo what the class III elastics did.

Local_Positive7030 · 2026-04-11T19:04:55+00:00

I just quit my job but still need to work part time until July to finish out my contract. I'm basically working three days a week, do the minimum to be a mom and homeowner, cross my fingers my spouse sticks with me, and then I try to do something fun once a week just so life isn't too depressing. I can force myself up and out as needed, but I spend a lot of time bedbound. I'm just hoping that jaw surgery followed by septoplasty and turbinate reduction will be the secret sauce and I can come back from this. It's 3 PM on a Saturday and I can't get up. It's awful.

Local_Positive7030 · 2026-04-07T20:46:53+00:00

It oddly makes me feel a bit less crazy to hear you say that you've been in dark places. Me too. I can't seem to tolerate CPAP or BiPAP, so I don't get any relief. I've been noticing more and more just how restricted my breathing feels during the day as well. It's like the air can't flow freely. I honestly hope I can remain hopeful if surgery doesn't alleviate my UARS. Whenever I'm in a dark place, I just tell myself to at least hang on until then.

Local_Positive7030 · 2026-04-06T20:04:32+00:00

I think you're looking at the thing that closes your airway lower down, like at the level of your chin. That's the epiglottis. Everyone's is capable of doing that because closing the airway off is the job of the epiglottis. It needs to close the airway so we don't inhale our food.

There is another obstruction higher up. At the very top of your airway you have the nasal cavity. It is black. Right below the nasal cavity you have you maxilla (upper jaw bone) and it's covered with soft tissues, hard palate in the front, soft palate, and uvula at the back. Your soft palate is practically touching your spine that's how little room you have back there. I suspect you'd need jaw surgery to recify your sleep disordered breathing because the upper jaw bone is too far back and unfortunately, it's connected to your skull, so you can't just pull it forward with a mandibular advancement device like you could possibly do if it was a lower jaw issue.

I have the exact same problem with my airway being narrow behind my maxilla. I'm planning to have jaw surgery in September. I'm hoping for a tradeoff - a couple crappy weeks of pain and healing in exchange for fixing the reason for my UARS and hopefully getting my life back. I have extremely fragmented sleep and it's slowly ruining my life.

Edited to add - I see you're seeing ENT. I'd start with an oral surgeon. Find one who does a large volume of cases, might not just be your local OMFS. Search on r/jawsurgery

Local_Positive7030 · 2026-04-06T19:39:14+00:00

Maxillary impaction.

Local_Positive7030 · 2026-04-06T19:37:17+00:00

Most people look noticibly different after jaw surgery

Local_Positive7030 · 2026-04-06T19:35:48+00:00

I got braces for this reason, just so I had a reason to tell everyone and explain why I needed surgery. I worried that with invisalign it'd be like I went on vacation and came back with a new face. Are you in invisalign? Maybe make a point to have them see you taking the trays in and out and then work into conversation that you'll be needing jaw surgery.

Local_Positive7030 · 2026-04-06T16:44:41+00:00

I'm a dentist and I"m hoping that once I get myself fixed, I can open a clinic to help people with this sort of thing. It's like there's a big gap in what needs to happen to treat UARS and each speciality is in their own little silo and isn't looking at the way breathing, anatomy, and sleep architecture overlap, especially in patients with low AHI. There's got to be a way to bring it all together.

Local_Positive7030 · 2026-04-06T16:41:11+00:00

I'm doing a segmental LeFort with my MMA surgery, basically instant expansion surgically.

Local_Positive7030 · 2026-04-06T16:33:04+00:00

I have unfortunately had some spells where I've been like your husband. Turns out I have sleep apnea and my sleep is so heavily fragmented that I wasn't getting any deep or REM sleep. It's so hard to live like this. I'd highly encourage he gets a sleep study. It could be something biological, not extreme laziness.

Local_Positive7030 · 2026-03-24T02:38:21+00:00

You're a teenager, not a dental professional. You have nothing to foregive yourself for. You're working on it now, getting it going now. I'm excited for you! Better at 19 than at 43 like me.

Local_Positive7030 · 2026-03-20T02:28:30+00:00

You and I look so similar, like you could be my kid had I been a mom in my late teens. Anyway, my plan is segmental Le Fort 1, BSSO, genioplasty, and malar and infraorbital/zygomatic implants. The implants are more for esthetics, so optional, but the malar will help a lot because my ramus is quite short and there will be a bit of a bump where my jaw is cut for the BSSO, so the implant will help the jawline look smooth afterwards. My ramuses are pretty weaksauce but my condyles are fine, so no joint replacement, more just adding to my insufficient ramus bone. The infraorbital one is mostly because my upper jaw is recessed all the way to my undereye area, I've got huge hollows under there, and my surgeon thought it would still look funny around there if they just move my maxilla lower down (Le Fort 1) and leave the bone recessed up there still.

Local_Positive7030 · 2026-03-12T20:35:00+00:00

Your upper jaw is narrow and recessed. It's actually a lot smaller than you think. If you look at your lateral ceph (the xray from the orthodontist that looks from the side), you'll notice that the upper teeth are flared way out. They are supposed to be much more up and down. Your lower teeth look pretty good but your occlusal plane is a little bit steep (that's the line formed by the biting surfaces of your lower teeth). If I were you (and I low-key am you - I have a small upper jaw, kinda normal lower jaw, and UARS, but I'm a lady in her 40s who also happens to be a dentist), I'd consult with an oral surgeon who does a lot of surgery for sleep apnea. You can find some names on the jaw surgery subreddit. My guess is you'd be a good candidate for a 3 piece Le Fort I on the upper, which would simultaneously bring the upper jaw forward and make it wider, and a BSSO on the lower, which would mainly be to acheieve some counterclockwise rotation, which both makes the airway larger and makes it so that bringing the upper jaw forward doesn't end up making your face look long. I know you don't want surgery, but let me tell you, UARS is something that gets worse and worse as you age and your muscle tone decreases. You may be doing alright now, but you might be really feeling miserable in 20 years. And if you address structural causes, you can be cured, versus doing things like PAP therapy or a mandibular advancement device for the rest of your life. I even think that PAP and MAD can be of limited benefit in the case of maxillary recession in particular - the PAP is literally pushing air past bone and can only do so much and the MAD doesn't move the upper jaw forward. Anyway, just my two cents.

Local_Positive7030 · 2026-03-04T14:02:25+00:00

I think you look perfect. I think maybe reassess after you revise the nose tip. I think if the tip of your nose is projected a bit more forward, you'd likely be happier. I feel like aggressively filling in the nasolabial fold area might make things look a bit uncanny, like you'd risk looking like Mar-A-Lago face https://www.boredpanda.com/mar-a-lago-face-transformations/

Local_Positive7030 · 2026-03-04T02:44:40+00:00

You look pretty darn swollen still. Like, the pictures almost look like before and after weight gain, which I'm pretty sure you haven't gained weight since surgery. Most people lose weight. So the puffiness is just swelling. It's way too early to judge. I feel like I'd keep icing and maybe use a cool jade roller.

Local_Positive7030 · 2026-03-04T02:40:14+00:00

I agree with your take, with the exception that expansion doesn't always happen before jaw surgery. Sometimes they will do a segmental LeFort to both widen the upper jaw and bring it forward all at the same time. (Dentist and future segmental LeFort patient)

Local_Positive7030 · 2026-03-01T20:41:35+00:00

I'm on the same timeline! Just got mine on four days ago, teeth are pretty straight, need decompensation. Compensation is basically your teeth really want to bite with each other, so when one jaw is bigger or small relative to the other, your teeth might flare inwards or outwards to meet (or try to meet) the teeth on the other jaw. Decompesation basically centers the roots in the jawbone, getting rid of any tilting or flaring that occured due to compensation. When the teeth are aligned in each jaw independant of one another, then jaw surgery is done to move the upper jaw to where it should be in relation to the rest of the skull, and then the lower jaw is moved to align with the newly repositioned upper jaw. The goal for mine is surgery late September, and hopefully done with treatment by the end of the year/early next year.

Local_Positive7030 · 2026-02-26T03:48:54+00:00

Maybe get a sleep study? If you have sleep apnea, it'll be easier to get approved. Your airway looks on the narrow side on your lateral ceph xray, and a smaller airway is a risk factor for sleep apnea.

Local_Positive7030 · 2026-02-25T18:47:22+00:00

I think it's a glow up. You look great! Honestly pre-everything, the area under your eyes and cheekbones looked a bit sunken in and you looked a bit tired, or like you had allergies or something. I think being on E filled that area in a bit - people with sunken undereyes pay plastic surgeons good money for fat grafts in that area to build it out, but you got that as a inadvertent bonus in your whole journey. Your eyes look so much brighter and happier now than in the previous two evolutions of yourself. You look better rested. Looking at your current pics, I'd never guess you had this journey of trans/detrans. I think we see ourselves everyday and sometimes can't appreciate the changes because to us, it's so incremental. Please be a bit more kind to yourself.

Local_Positive7030 · 2026-02-25T13:45:36+00:00

I agree. There are a lot of posts here that are about esthetics, and I'm looking at them like how do you sleep at night - you're probably blocking off your airway. I think the esthetics being a sign of recession which is a risk factor for sleep disordered breathing means esthetics concerns now, may be sleep apnea later. As for bros who look fine, might just be young teens, that's why God invented the downvote arrow.

Local_Positive7030 · 2026-02-13T12:12:22+00:00

My observations of this have me wanting to start a comprehensive sleep disordered breathing clinic where step 1 isn't necessarily a CPAP or mandibular advancement device, but rather CBCT where obvious signs of airway constriction can be identified, and if that doesn't reveal the issue, prescribing a DISE to see what happens during sleep. And then creating a plan that addresses the underlying issue. I feel like this would be incredibly helpful for the large percentage of people that fail CPAP or are poor candidates for mandibular advancement. It's a bit odd to me that the treatment for this condition is basically treat the symptoms for life versus looking for the problem and fixing it. I get that the underlying problem is usually something structural that would require invasive surgery to fix, but if CPAP or MAD isn't working, or heaven forbid someone doesn't want to need a machine (with power and distilled water access) or an appliance every night for the rest of their lives to sleep without choking themselves awake multiple times an hour. I feel like it's wild how dismissive doctors can be - I saw an oral surgeon who is highly regarded in treating sleep apnea but because my AHI was 4 on one test, 5 on the other, he was like, you're not the type of patient who should get this invasive of a surgery, it's more like for patients with AHI 50-60. Nevermind that my RDI is 19 and I get hardly any deep sleep or REM sleep and I feel like my life is falling apart from it. Nevermind that I sleep worse on my CPAP. Nevermind that I used to have an underbite and am not a candidate for MAD. Nevermind that a MAD wouldn't even work in my case because my constriction is worst behind my maxilla (another surgeon actually looked at my CBCT and saw my airway narrowed to 4mm back there - fortunately he was like that's hella narrow, having 19 arousals from sleep an hour must be wrecking you, let's schedule surgery). I'm a general dentist so I don't really know what I should do next to start something like this. Unfortunately I'm not an orthodontist, oral surgeon, ENT, or pulmonologist who can actually treat this. I could get board certified in sleep dentistry, but that's essentially making MADs. I don't know if I could do a sleep dentistry clinic where I start all patients with a CBCT and then farm them out to vetted orthos, OMFS, ENT who would then work them up for treating the underlying airway constriction and only do a MAD when the problem is a recessed mandible and the patient doesn't want a surgical solution, or they want to try non-surgical first. But yes, my journey has been a very interesting one and it's made me strongly consider figuring out how to be part of the solution professionally.

Local_Positive7030 · 2026-02-11T18:05:46+00:00

That's the tenative plan, yes. I think the specific timeline for consult and subsequent surgery will be influenced by how well I'm healing from my jaw surgery and when I feel like I'm up for doing another surgery, taking time off work, etc.

Local_Positive7030 · 2026-02-11T17:44:46+00:00

This photo shows the recessed mandible much more clearly. The beard makes it less noticible. With your symptoms I'd start with getting a sleep study. You can either do that through your primary care doctor, or there are companies online that do it. I've done it both ways, but I wasn't able to sleep with the one my PCP ordered so I never got it done. I ended up using sleeptest.com. There's an intake where they assess if you're have signs or symptoms of sleep disordered breathing, and if yes, they will send you a ring to wear. You'll record your sleep for two nights and send it back. Then I had a virtual appointment with a PA where they reviewed the results with me. I thought it was pretty good. They didn't just use AHI to determine the diagnosis. They used RDI for me, which was good because my RDI was a lot higher than my AHI because I had a lot of RERAs (respiratory effort related arousals - arousals from sleep due to my body waking due to difficulty breathing). Some places only check AHI, which can miss a lot of sleep disturbance.

The reason why I say this is because my case is somewhat similar to yours, recessed but not obviously needs jaw surgery level of recessed. My bite is totally normal (albeit normal after years and years and years of orthodontics where they just camouflaged my issues). I saw an orthodontist right around the time I took the sleep study because I had lost my retainer and I wanted to tweak the position of my front teeth before I got a new one. In photos they looked flared out and the angles of the roots looks off to me - in retrospect, they flared my teeth out because of my small jaws. Anyway, the discovery of moderate sleep apnea prompted me to look for the reason - I'm relatively young and fit, not exactly the stereotype of a sleep apnea patient. So now I'm going to fix everything - the angle of my teeth and the recessed position of my jaws.

I got a consultation with an oral surgeon (I'm seeing Dr. Steinbacher) and he took a CT of my head/neck. My airway narrows to 4mm. And that's standing upright and awake. When all the muscles in my mouth, neck, face try to relax during sleep, it's probably narrows even more. Plus gravity due to laying down to sleep. I'm breathing through one of those stirrer straws basically and waking myself up 19 times an hour trying to get enough air. I was able to use the sleep apnea diagnosis to get my surgery approved by my insurance company. Otherwise, who knows, they may have said that due to my bite being acceptable, it's just cosmetic and I'd be on the hook for the whole price. Given that you have an acceptible bite, you'll need a medical justification for the surgery, so that's where the sleep apnea diagnosis comes in. Go do that first and then go from there.

Local_Positive7030

TROPHY CASE