November 2023

Why Isn't My Botox Working Anymore?

Reasons Why Your Botox Isn't Lasting

The neuromodulator known as Botox Cosmetic treatment works to relax muscles, preventing muscle contraction and softening dynamic expression over time.

As our collagen stores become depleted and our facial muscles contract, skin settles on and in dynamic ridges and valleys formed by repetitive facial movements. Wrinkles form, communicating frustration and tiredness, in the upper third of the face. These wrinkles most notably etch deep lines at the forehead, frown lines (11’s), and crow’s feet. Botox Cosmetic smoothes the facial skin by diminishing the appearance and strength of our dynamic expression, and telltale wrinkles of facial aging.

Daxxify daxibotulinum toxinA-Ianm injection

Other neuromodulators include Dysport, Xeomin, Jeuveau, and Daxxify. These similar products vary slightly in their mechanism of action, the spread of toxin effect, longevity, and result. Injectors and/or patients may feel that one product provides them with superior results.

Neuromodulating treatments are easy on the patient and can be done in about 5 minutes. The results can last anywhere from 3 to 6 months with the longevity being directly related to dosing. More products (units) used generally correlate with more muscle relaxation for a longer period of time.

Botox patients typically develop a “routine” of maintenance treatments at an average of every 3-4 months. Botox dosing will vary slightly from patient to patient, but typical doses for treatment are 25 units, 35 units, or 50 units. Younger patients with fewer wrinkles require fewer units while older patients or patients with thicker muscles require more units.

Over time many patients notice that their Botulinum toxin treatments are either not as effective or don't last as long. There are many reasons for this and things that can be done to maximize the results.

Things To Consider

Know Your Dose

Your injector should provide you with a “Botox map” showing where you were injected and how many units were placed into each injection point. Botox won’t be immediately effective. It can take up to 2 weeks for the final result to emerge. If at 2 weeks, you are still seeing movement and wrinkles you’ll likely need more units to immobilize the deep contractions caused by muscle movement at the upper face and finalize your unique dosing and injection map.

If you’ve switched injectors or clinics, you might want to ask about their protocols. Botox should be mixed or constituted using a new vial. The duration of botox activity diminishes the longer the vial sits unused. Like with any other medication, a botox vial should be used immediately or shortly thereafter to ensure it’s effectively.

Beware of Low Cost Botox Injections

Unfortunately, it happens. Extreme Botox specials and below-market pricing are red flags you'll want to pay attention to. If the offer seems too good to be true, there's usually a catch that you may not have considered. The injector could be inexperienced and is needing practice or perhaps the practice over-purchased and has soon-to-be expiring product they need to offload. These type of “Groupon” injectors and practices can also be using product that has been watered down or overly diluted.

Some injectors and practices price Botox by the “area” versus the unit. If you pay by the area, you don’t know how many units were delivered and if you'll get a corrective result. Make sure you are getting the exact number of Botox units you paid for, and use an experienced injector.

Remember that the different neuromodulators will have different unit amounts. For example, Dysport is about 3 times the number of units as Botox for a similar treatment. A 25-unit treatment of Botox would equal a 75-unit Dysport treatment.

Allergan, the makers of Botox Cosmetic, offer Botox patients Alle Rewards which offers you savings on their portfolio of products. If you're looking for ways to manage your treatment touch ups and maintenance costs, consider downloading Alle and get rewards delivered straight to you.

Do You Want "Full Freeze" or Some Movement?

In my practice, most men and women don't want to be completely "frozen." They desire elevated brows, softer movement, and smoother skin. Lighter doses of Botox require fewer units, but keep in mind that a sprinkle of Botox will require more frequent "tweakments" to maintain their result. More units are needed for the patients who prefer zero movement or expression but the results last longer.

Every Patient Is Unique

Are You Thin or Athletic?

Thinner and more athletic patients with low body fat are known to metabolize most medications, including Botox and fillers, at a fast rate. While there is no definitive scientific explanation for this, the anecdotal evidence supporting this is beyond argument. This does not mean that the products are ineffective but rather that they simply don’t last as long in these patients.

Covid Vaccinations Might Be Playing A Part

Some patients experienced swelling after filler injections after the initial COVID-19 vaccines. While the link between the virus and vaccine has not been proven, the current thinking is that the effect on the immune system might lessen the effectiveness or duration of the botox treatment. Vaccines act to ramp up the immune system which allows the body to fight a particular infection. This enhanced immune response might lead to more antibodies against a particular neurotoxin, making it less effective.

You Might Be Making Antibodies

There is some science that suggests that your body may develop antibodies to Botox, making it less effective. This tends to happen in people who have had repeat injections of the same neurotoxin over many years. The current thinking is that about 10% of patients might have an antibody against Botox and won’t respond as well.

Your Botox Might Be Working Fine, And You're Just Getting Older

As we age, there are other factors that compound the aging process. Genetics and the environment cause our skin to age and deteriorate. Deep wrinkles emerge as a result of gravity and volume loss. Your Botox may be working just fine but these other factors begin to become apparent and should be addressed. Different treatments or a combination of treatments may be necessary as we age.

So What Do You Do? Start Here:

Get More Units

If you’re Botox is not lasting as long, talk with your injector about your dosing. Make sure you're getting the right amount of units so that your treatments last. If you’re getting 25 units then try 35 units and dose from there. It also makes sense to evaluate your treatment intervals and consider more regular treatments if you're noticing a lapse in time between appointments.

Try A Different Neuromodulator

You might be resistant to a particular product as a result of making antibodies to a particular product. If you’re getting Botox, try another product. Botox, Dysport, and Jeuveau contain stabilizing proteins. Daxxify is made with a peptide. Xeomin does not have proteins. Ask your injector if a different product might be more effective for you.

Find An Injector Who Understands You

Make sure your injector is a qualified physician or nurse with a proven track record and years of experience. Most will have certification and be happy to share before and after results with you. You should feel comfortable with your injector and be able to ask any questions. You should be given a “Botox map” showing how many units you received and in what location on your face. You need to know your units and make sure you are receiving the number of units you pay for. Make sure you know the product being used is fresh and hasn’t been sitting around. Don’t Botox shop looking for the best deal. Cheap Botox is usually poorly done and not very effective.