Botox vs Surgical Removal of Posterior Temporal Muscle

Q: Dr. Eppley, I am a 22-year old male. My temporalis muscles bulge at the sides which makes me look like an alien. Because of the my protruding posterior temporalis, my hat size is 58cm, and even that feels a little tight. 

I heard that you’re one of the few surgeons that can surgically excise the muscle. You’ve mentioned in your blogs that a 7-9mm width reduction each side can be expected from the surgery.

However, I’d like to try out botox first to see if I’d like the final look. However, since botox only shrinks the muscles and doesn’t remove it:

1. How much width reduction per side can I expect from botox? Will it be considerably lesser than the 7-9mm through surgery? Is 4-5mm reduction per side through botox possible?

2. How many units do you recommend per side? I’ve seen doctors quote a range from 25 units to even above 50 units per side.

Thank you!

A: In answer to your questions:

1) The effects of Botox compared to surgery would be less than 20%.

2) You would likely need 100units per side to get a really noticeable muscle temporal reduction effect.

Dr. Barry Eppley

Indianapolis, Indiana