Masseter Muscle Reduction

Q: Dr. Eppley, I’m interested in masseter muscle reduction and am aware you offer electrocautery as a treatment. I have a few questions regarding this procedure : 

1) Is it permanent? I understand Botox is used for this as well but it is temporary and radio frequency has also been used but lasts only for a couple years. I am looking for a permanent solution. 

2) Are the effects significant? I have seen the effects of Botox for masseter reduction and I really liked it but as I previously mentioned the effects wear off. Will electrocautery provide the same effects or is it more subtle? If I find the result too subtle could I possibly come in for a second treatment? 

3) Will there be any complications such as nerve damage, eating/movement limitations, premature sagging skin, or asymmetry? 

4)  Also, I have a dental Herbst appliance. Would that be an issue?

I look forward to your response. I apologize for the many questions.

A: Electrocautery is a form of surgical masseter muscle reduction. Somewhat similar to radiofrequency, it is a method of causing direct thermal injury to the muscle resulting in permanent loss of some muscle fibers. Unlike radiofrequency it it done through an open approach intraorally where the undersurface of the masseter muscle is treated. Through a combination of subperiosteal muscle release and direct electrocautery the size of the muscle mass is decreased as it heals. To answer your specific questions:

  1. Those muscle fibers that are directly thermally injured does result in their permanent loss. However, like liposuction which permanently removes some fat cells but weight gain can return by those fat cells that remain undergoing hypertrophy, the same can be said for muscle tissue. If the cause of the masseter muscle hypertrophy persists the remaining muscle fibers can become hypertrophic and muscle volume returns.
  2. Generally the effect masseter muscle reduction by electrocautery are similar to the effects of Botox injections. Further reductive treatments can be done.
  3. Other than some temporary muscle stiffness (trismus) there are no other adverse effects. It is just an aesthetic question of what degree does the overall muscle mass shrink.
  4. An indwelling oral appliance is not a preventative factor for having the procedure.

Dr. Barry Eppley

Indianapolis, Indiana