What is Botulinum toxin? Is it toxic? Botulinum toxin is not as scary as its name implies. Many beauty places refer to it as biological wrinkle removal, or genetic wrinkle removal, in order to eliminate the fear of people. Botulinum toxin is a biologic product that can be mass produced through genetic engineering methods. It is very commonly used in neurology, ophthalmology, plastic and cosmetic surgery because of its nerve blocking effects. The current dose used is only one percent of its maximum safe dose, so it is very safe. How long has Botulinum toxin been used for cosmetic purposes? In 1986, Mr. and Mrs. Carruther in Canada accidentally discovered the good wrinkle-reducing effect of Botulinum toxin when they used it to treat eyelid spasms. The Carruthers became the inventors and pioneers of this technology. Why is botulinum toxin used to treat bite muscle enlargement? Why not remove the muscle directly? Women with oval shaped faces are often asked to have their jaws reshaped because of the enlarged jaw angle. In our department, we perform several hundred cases of jaw angle osteotomy every year (see the article “Square face to melon face”). More than 90% of these patients have benign bite muscle hypertrophy and want to reduce it at the same time. Since it is difficult to grasp the amount of muscle removal and the depth of muscle removal during surgery, not only is the result unsatisfactory, but it is also easy to increase the chance of bleeding, hematoma and infection, resulting in serious complications such as asymmetry on both sides of the face, facial nerve paralysis, dental closure and prolonged muscle spasm, which has not been possible for them. In 1994, Smyth et al. reported the use of botulinum toxin for the treatment of bilateral facial hypertrophy. In 1994, Smyth et al. reported their experience with the use of botulinum toxin in the treatment of bilateral bite hypertrophy, which was considered a revolutionary new method, and Smyth recommended this technique as a routine treatment for “chewing muscle hypertrophy”. Botulinum toxin injections shrink and reduce the size of the bite muscle through denervation, making the treatment more complete and solving this problem, and increasing the patient satisfaction rate and the number of patients seeking treatment. The combination of Botulinum toxin injection and jaw angle surgery has obtained a good effect of 1+1 is greater than 2 in the treatment of fat face. Combined with facial liposuction, cheekbone reduction and widening, greater improvements in fat faces can be achieved. How is Botox used? Generally 1 to 3 injection sites are selected on each side for injection. The injection should be done as slowly as possible, and there is no need for local massage or other special treatment after the injection, as normal chewing movements can gradually spread the drug in the muscle tissue. When does Botulinum toxin type A take effect? Two weeks after the injection of botulinum toxin type A into the bite muscle, the patient can feel a decrease in chewing power when chewing hard, and there is no obvious bulge and fatigue in the bite muscle, and there is no obvious contraction of the bite muscle when touched by hand locally. Atrophy of the bite muscle and changes in the shape of the face can usually be observed 1 month after the injection of Botulinum toxin type A. What are the possible adverse reactions? As a muscle injectable, Botox has no significant side effects and offers more advantages than traditional surgical methods. Local adverse reactions to Botulinum toxin type A injections include excessive weakness of the occlusal muscles and the corresponding manifestations due to the spread of Botulinum toxin to the adjacent muscle tissue, depending on the injection site and the dose of Botulinum toxin injected. Individual patients have been found to have fever, discomfort, and fatigue after botulinum toxin injection. These clinical manifestations are usually transient and disappear on their own within a few weeks. Will there be a recurrence after treatment? The bite hypertrophy can be cured after botulinum toxin injection if care is taken to avoid frequent chewing movements (e.g. chewing gum, getting high on melon seeds, etc.). Once there is a recurrence, it can be injected again. What are the other methods of comprehensive treatment for fat face? Besides botulinum toxin injection and jaw angle curved osteotomy, there are also facial liposuction, cheekbone reduction and widening methods. The combination of treatments can lead to a greater improvement of the chubby face.