
Compensatory masseteric bulging is a new complication in East Asians after repeated botulinum toxin injections targeting only the lower masseter. This study highlights the need for a retrograde, layered injection technique across all muscle layers, guided by ultrasound, to prevent asymmetry. A case study showed restored symmetry after upper-layer treatment. Personalized dosing and anatomical precision are essential to avoid uneven atrophy and optimize facial contouring results.
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