I tried Botox for TMJ and have some insights to share on both the upsides and the downsides to it.

I went through a variety of different treatments before I resorted to Botox to help my TMJ, and while the Botox was the only thing that was effective at stopping the pain in its tracks (upside), it also completely changed the shape of my face (downside.) The good news is that my face shape recovered – and that I eventually found a different treatment that works really well for me.

My TMJ came on at a point that I was stressed out TF out. (Which, of course, is common – as it’s tension related in one way or another.) The new pain also coincided with my starting vocal lessons, which could be totally unrelated, or my new found desire to open my mouth and belt could have just pushed my face muscles over the edge at a time they were already resisting.

It actually took me a couple of months to understand that what I was feeling was TMJ at all, during which time it got progressively worse. My bad.

The pain started as a hot, achy type of feeling that extended from my jaw and up to my cheekbones. All over the sides of my face. Eventually, it got so intense that my masseter muscles got rock hard and swelled my face into a burning, square-ish thing. I was icing every hour or so and deeply massaging the sides of my face with my knuckles while crying for a few weeks before I even figured out what it was. I don’t grind my teeth, and in my mind at the time, those things are linked together.

I wasn’t thrilled that the pain got worse, but when it did I could more easily identify which area of my face was really being affected. So I took my specific symptoms to the internet and learned what I needed to know.

TMJ, (AKA TMD, TMJD, TMJ Syndrome), is short for temporomandibular joint. The added “D“ in those acronyms is for “dysfunction.” Any of those can be used to describe the pain and movement issues caused when the jaw joint and the muscles that surround it get inflamed. In addition to pain, some people also experience that tell-tale clicking, for others, the jaw can lock up entirely.

Please see this illustration, courtesy of Authority Dental, which tells you (pretty much) everything you need to know:

Besides the fact that TMJ wildly uncomfortable, it’s also not good for you. When the jaw joint clicks and grinds it causes wear on the bones. In extreme cases that can cause some big issues over time. You may be interested in doing a Google image search on advanced untreated TMJ…or perhaps you don’t want to do that at all. Depends on your mood.

In my online research, I also discovered that women are more likely to get TMJ than men, and that it can be caused by a variety of things. The most commonly referenced reason is grinding the teeth, but that’s definitely not the only cause. General stress can cause inflammation that might reignite other tensions in the body, which can head on up to the face too. (All of our muscles are connected after all.)

I uncovered a few things in my research that made me wonder if my own TMJ could be related to other muscle stress in my neck and shoulders. I tend to hold a lot of tension in that area anyway and I spend a lot of time working at a computer and wielding a phone. (As many of us do.) Also, back in college, I once jammed up my neck and broke my nose while cheerleading. (I caught a flier’s fall with my face. Shanelle is fine.)

That came to mind after I read that some cases of TMJ can be traced back to ten-year-old neck injuries.

Attempting to Treat TMJ

Once I identified that I was most definitely experiencing TMJ, I tried a few different things outside of ibuprofen and ice, such as acupuncture and some other gentle muscle manipulation therapies like CranioSacral therapy. I also went to yoga, applied heat, rubbed magnesium gel on my face, and tried both internal and external forms of Arnica.

While I did find all of those other treatments very helpful in general, none of them were immediately and fully effective at calming down my face. Had it been a more mild case I might have given them all a bit more time to work their magic, but the level of pain at the time was consuming and it was affecting my workdays. So I resorted to Botox.

The Upside to Botox for TMJ

The first time I went in to get the Botox, they used the smallest amount possible that should still make an impact. That’s definitely something I would suggest with a neurotoxin like Botox, especially if you’ve never had it before and don’t know how your body will take it. (Some people only need a tiny bit, other people can be totally immune to it. It’s not a perfect science.) Of course, it also goes without saying but I’ll say it…only get Botox from a licensed and experienced practitioner.

The procedure itself is mostly painless and extremely fast. I think it was four different pokes in total. While it takes about two weeks for Botox to take its full effect, my muscles were so inflamed that I could start to feel a difference almost immediately. The pain started reducing dramatically and within a week or so the swollen square shape of my masseter started to go down as well.

After one month in I felt totally normal again. I was fixed! But then two months in…the Botox started to wear off and the pain came roaring back with wild intensity.

The Downside to Botox for TMJ

While a bummer, it’s not a surprise that the Botox quickly wore off. We used a small amount of Botox and it can take a few doses to work out the right levels, so I went back for another round. Again, the Botox stopped the pain really quickly. But with my second dose of TMJ Botox on top of the first…the muscle freezing went from just reducing the pain to dramatically slimming down the sides of my face. Way too much.

The thing is, face slimming is expected to happen when you shoot Botox into the masseter muscle. In fact, a popular Botox treatment is using it cosmetically in the TMJ area to reduce the size of people’s jaws. And it works like a charm. This happens because the neurotoxins in Botox limit movement in the muscle, and lack of movement in any muscle will lead to atrophy. (Ie; shrinking.) I know it’s sort of hard to imagine that your face is that buff to begin with, but all that talking and chewing and whatever else you do with your mouth is occurring thanks to some pretty solid face muscles. The Botox doesn’t noticeably restrict your movement in that area, but alas, the muscles still shrink down.

If you happen to be treating TMJ and also have a wide jaw, you might absolutely love what it does to your face. But if you already have a slim face or very v-shaped lower face as I do, you might feel like your jaw straight up falls off.

I didn’t have a lot of jaw to spare, so the Botox slimming effect literally led to some empty spots that looked like holes along my jawline, and it looked like I lost about 15 pounds that I didn’t need to lose.

And I swear this was not just my own harsh critic thinking that it looked bad. I went out to eat at my favorite L.A. Mexican restaurant El Coyote, and a waiter who recognized me condescendingly gestured to my jaw and said I looked too thin.

First of all, mind your own business sir. Second, I KNOW.

(This jawline mishap also coincided with my frying off half my hair…which we will discuss another day. That’s another important story. ‘Twas a strange year.)

So naturally, since I looked absurdly thin and not super cute, I wasn’t really keen on repeating the Botox experience. Luckily I have not had to…but it’s not because the pain completely stopped. It did stay away for a very long time. In my experience Botox works longer than anticipated. But eventually, I started to feel the pain returning, and I was ready to try some other options.

What Really Fixed My TMJ

Here’s what definitely did work for me when the pain started creeping back: the chiropractor.

In addition to releasing some of the all-over muscle tension in my shoulders and neck that were causing issues in my face, the chiropractor actually went inside my mouth with a (gloved) finger and did some myofascial release on the jaw muscle. (That’s the same concept as using a foam roller on your body.) It was extremely painful and the best release ever at the same time. That immediately helped and within the day the muscles in my face were no longer swollen at all. She was also able to realign my jaw, which apparently was biting slightly off to one side.

It’s also possible to do this myofascial release to your self, which I have done as well. It’s not as incredible as having a professional do it, but it is effective at stopping the pain from coming on. In fact, I only had to the chiropractor do that to my jaw once and it’s never fully come back. The last time I went she adjusted my back and all my over-work-at-a-computer issues, but she didn’t need to adjust my jaw at all. So for me, that is the key.

(If you are interested in learning how to do it fo yourself, there are a billion YouTube videos on this topic. Click here to be faced with many choices.)

Interestingly, the chiropractor also suggested that I cut down my time spent sleeping in my Invisalign teeth trays. (Which are retainers at this point.) I stayed in the habit of wearing them for years after finishing my teeth straightening treatment because the first time I had braces I did not wear my retainers long enough. Hence the round two with Invisalign. But she suspected that I might be clenching onto the trays while I sleep, despite not having a grinding habit in general. It sounded plausible so I started spacing out of my wears of those as well.

(If you are in Los Angeles I would happy to refer you to my awesome chiropractor, who often has her golden retrievers in office, only adding to the delightful experience.)

As of writing this, I have no TMJ pain at all. Occasionally my jaw clicks, but it doesn’t hurt or restrict any movement. As for my face shape, after quitting the Botox that also did eventually return to normal. Woohoo! But it took a while.

While I was deep in my skinny jaw phase I read that it can take about six months for the face shape to return to normal once you quit the TMJ Botox. (And there are a lot of people on online forums out there asking for help with this very topic.) But I would say that mine took more like a year to get back to normal. It was long enough that I wasn’t sure it was ever going to happen. But it did. I have a great timeline reference for all of this because I happened to meet my boyfriend during that strange year while I had a weird jaw, weird hair, and was deep in a period of depression. (The depression preceded those things.) That too, is another story for another day.

So the moral of my story is that I could have avoided melting off my face had I just gone to the chiropractor and treated the root cause of the issue. But hey, now we know.