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Twenty-six women complaining about lower third facial enlargement due to MH, received 75\u00a0U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3\u00a0months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n\u2009=\u200911) or BoNT-A: (G2; n\u2009=\u200912). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6\u00a0months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman\u2019s test and Mann\u2013Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6\u00a0month follow-up (p\u2009&lt;\u20090.02). For EMG, significant differences were evident at the 6\u00a0month assessment, with higher masseter activity for G1 (p\u2009&lt;\u20090.05). For masticatory performance, no significant differences were observed throughout the study (p\u2009&gt;\u20090.05) and a higher improvement in subjective perception of MH was observed in the 1\u00a0month follow-up for G2 (p\u2009&lt;\u20090.05). 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