TMJ tension is miserable and night guards only do so much, so I really feel for you. The thing that finally helped me was therapeutic face massage at SENSO Skin Experts https://sensoskinexperts.com/ in Manhattan. The specialist worked on the jaw and the surrounding muscles, and after a few sessions the clenching tension dropped noticeably and the puffiness in my lower face went down. It is all hands-on, non-invasive technique, no injections or anything aggressive. My jaw genuinely felt looser and my face looked less tight afterward. If you want to try the massage route for TMJ before anything more drastic, I would book a session with them and see how it feels.
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