My Teeth Grinding Changed the Shape of My Face

Three months ago, the woman who does my eyebrows suggested that I wear my hair half-up, half-down to soften my "square face."

People have called me a lot of strange things, but no one had ever called my face square. Round? Yes. Distinctively Midwestern? Absolutely. Square? Never. I locked myself in a toilet stall and reviewed photos from high school when I hated the world on a more theoretical basis than literal. When I ventured out to the mirror, I looked at myself side-to-side and then head on. There was no denying it: My face had squared. My life felt like a horror movie all over again. I was sexually assaulted when I was 17 and developed post-traumatic stress disorder (PTSD) soon afterward. I lost my faith in humanity, quickly followed by my ability to sleep through the night. Then, my body ached from constant tension. Finally, my face squared.

But how? It turned out to be sleep bruxism, colloquially known as "grinding your teeth." Apparently, this can actually change the shape of your face by thickening the lower jaw. "With people who have sleep bruxism, the muscles go into hyper-function," says James Mah, a professor of clinical science at the University of Nevada, Las Vegas Dental School. "Much like a bodybuilder that's doing repetitive exercise day after day, the muscles enlarge." According to Mah, bruxism also causes side effects ranging from facial soreness to poor sleep (bingo). If left untreated, he explains, "the teeth get shorter [from being ground down] It's not a good look…In layman's terms, you end up with ‘square face syndrome.'" "All of dentistry has no solution," Mah tells me, but oddly, the research indicates there's hope in Botox. Better known for smoothing brows and occasionally giving men a smoother scrotum, the neurotoxin can also be injected into the masseter muscles of the jaw. This partial, temporary, paralysis aims to prevent people from biting down so damn hard. Eventually, the masseters atrophy, which slims the face. After several mesmerizing hours of reviewing before-and-after shots on dermatologists’ websites, I wondered if it could treat my PTSD so I could have more than just the appearance of happiness. While there’s been a decent amount of research on using Botox to treat depression, less is known about using it to treat other psychiatric conditions, says Daniel Z. Lieberman, a professor of psychiatry and behavioral health at George Washington University.

In his clinical practice, Lieberman uses Botox in the corrugator and the procerus muscles of the forehead to treat patients with social anxiety disorder and borderline personality disorder, both with positive effects. "The brain sends out signals to the muscles to communicate emotional states," Lieberman tells me, "but it's not a one-way street. The nerves send information from the muscles back to the brain." I ask Lieberman if Botox in the forehead might help with my symptoms—the teeth grinding that could very possibly be due to my PTSD—and he tells me it’s definitely worth a try. But one of the hallmarks of PTSD is that your fight or flight response is in a constant level of overstimulation so people with PTSD are more likely to experience grinding of their teeth and clenching that can lead to pain, he adds.

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Getting Botox in general for this purpose felt kind of felt like a cop-out. In addition to going to therapy, I was supposed to start doing yoga or meditating or just generally chilling the fuck out. Botox might not help my PTSD symptoms, and even it does, I might still end up with ‘square face syndrome' (the effects are temporary, after all). Lieberman reminds me, though, that if I did want to give it a try, that any negative side effects are very unlikely. "The only drawback is the cost. You need substantially more than for cosmetic purposes and insurance doesn't cover it."

I worried that getting my forehead frozen would impair my ability to contort my face in anguish (which seems key to my experience in psychotherapy), so I ultimately opted for masseter Botox and prayed for a psychological benefit from relieving the tension in my jaw.

I went to Spring Street Dermatology, where Joey Pang, a physician’s assistant, asked me to clench my jaw. "Very strong," she said. Pang then explained to me that it would take several weeks for the paralysis to set in and several more weeks for any visible changes. She warned me that if the Botox worked, I'd have to re-up every three to four months to keep the benefits going. After three "bee stings" in each cheek, I walked out into Soho feeling like I'd shed more than the $550 I shelled out. The tension in my face was gone. This was likely a full-on placebo effect but it was the best I'd felt in months. Over the next few weeks, I felt less soreness in my cheeks and less tension in my face. I slept better and felt more relaxed. Then, a month after the procedure, I caught my reflection in the mirror and stood, stunned: I recognized myself again. I asked my friends if they noticed my face slim out. "You look exactly the same," one told me, "maybe a little skinnier." (Pang had warned me that I might get sore while chewing, which might lead me to eat less than usual.) No one I surveyed could tell any difference at all. My selfies all differed in angle and lighting, making a comparison inconclusive. This lackluster feedback didn't dull my enthusiasm, no matter how ridiculous "jaw botox" sounds, how vain my square-face phobia makes me seem, or even that, according to Lieberman, I would have been better off with the forehead shots. As I reach the three-month mark of my masseter Botox, I can feel soreness encroach on my face. I'm on the fence about whether to get more Botox. How much am I really willing to pay to pretend that trauma is primarily a dental problem? But if I do get more, I'm definitely getting my forehead done. Fuck the therapeutic process: I can already see frown lines coming in from all that anguish. Pang helpfully let me know that the second area is half price.

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