An Expert Look at Hannah Berner’s Masseter Botox Video

Comedian and “Giggly Squad” podcast co-host Hannah Berner recently went viral after sharing that she couldn’t smile following masseter Dysport injections at a new practice, despite having received the same treatment twice before without issue. Masseter Botox (or Dysport, or any neurotoxin brand) is a widely used and generally safe treatment, though it’s considered a more advanced Botox injection technique compared to areas like the forehead or crow’s feet.

We’re not here to speculate about any specific injector, since complications like this can happen even in experienced hands. We’re here to break down the science behind what most likely happened to Hannah’s smile, and how advanced injectors like Paige Brudzinski, RN, work to prevent it during masseter Botox treatment.

View Hannah’s TikTok Video Here

Clinical Note: Hannah’s treatment specifically involved Dysport. For the rest of this article, and to match how most patients search for and talk about this treatment, we’ll use Botox and neurotoxin interchangeably with Dysport unless we’re speaking to something specific to that formula.

Key Clinical Takeaways:

• What Most Likely Happened: Neurotoxin likely diffused into (or was placed too close to) the risorius, a small muscle that sits in front of the masseter and helps pull the smile upward.
• How Could It Be Avoided: A precise injection pattern, mapped to each patient’s anatomy and confirmed with a clench test before injecting, keeps the treatment contained to the masseter.
• The Benefits of Masseter Botox: Beyond slimming a boxy jawline, it can relieve teeth grinding, jaw clenching and related tension headaches.

The Treatment Complication

What Happens When Botox Migrates to the Risorius Muscle

The “risorius” is a much smaller muscle that sits directly in front of the masseter. It’s responsible for pulling the corners of the mouth up and back, which is what lets most people show their back upper teeth when they smile. A 2014 anatomical study published in Dermatologic Surgery found that the risorius overlaps with part of the masseter in nearly all (97%) of the humans studied.

The exceptionally close proximity of these two muscles makes precision that much more important.

Injection Pattern Is Everything This Close to the Risorius

When neurotoxin spreads into the risorius instead of staying contained to the masseter, the result looks a lot like what you can see in Hannah’s video: a smile that only shows the front teeth, without the ability to pull back and reveal the upper back teeth.

There Are Risks Associated With Any Neurotoxin Injection

Like any injectable, masseter Botox carries some risk of complications, even when it’s dosed and placed with precision. Most are temporary and resolve on their own as the neurotoxin wears off. These possible risks include:

• Smile Asymmetry or Limitation: Caused by neurotoxin affecting the risorius or nearby muscles instead of staying contained to the masseter. One study found this occurred in just 0.15% of 2036 masseter treatments.
• Parotid Gland Involvement: Swelling or changes in saliva production if the injection sits too close to the parotid gland.
• Bruising or Mild Soreness: A normal, short-lived response to needle placement that is typically well-tolerated by most patients.
• Uneven Results: One side may respond more than the other, especially in the early sessions with a new injector who is still assessing your anatomy.

“The best & worst part about Botox is that it doesn’t last forever. That said, there’s no dissolving agent for neurotoxin like there is for filler. Unfortunately for patients in a similar situation, they may have to just wait it out.” 

-Paige Brudzinski, RN

“I have patients clench multiple times so I can feel around the area for the masseter itself. Then I’ll do a specific injection pattern, usually 2 to 3 spots, to avoid hitting any other muscles. I always offer for patients to come back in about 2 weeks to make any tweaks if needed.”

— Paige Brudzinski, RN

The Functional Benefits of Masseter Botox

• Relieves Teeth Grinding (Bruxism): Eases the muscle tension behind nighttime clenching and worn-down teeth.
• Reduces Tension Headaches: A looser masseter often means less referred tension through the jaw and temples.
• Eases TMJ Discomfort: Can reduce jaw pain, clicking and stiffness associated with TMJ dysfunction.
• Supports a More Comfortable Bite: Patients who clench throughout the day often notice less overall jaw fatigue.

The Cosmetic Benefits of Masseter Botox 

• Softens A “Boxy” Jawline: Gradually slims an overdeveloped masseter for a more oval facial contour.
• Creates Facial Balance: Brings proportion to a lower face that appears wider than the rest of the face.
• Long-Lasting Results: Effects typically last several months per treatment, but don’t last forever – which is also a benefit.
• Virtually No Downtime: Patients can generally return to normal activities immediately.