It is important to seek an injector who is experienced and has good knowledge of facial anatomy.
I read your synopsis and several thoughts and questions came to mind – mainly those I would ask you if you were in my office with the same concerns. It sounds as if you have been satisfied with your previous BOTOX injections. Were you recently treated by the same injector that has treated you in the past? If not, why did you change? You know that you were treated with 36 units this last time. How many units have you typically received for previous frown line treatments? I don’t know your answers to these questions, but cheaper BOTOX is not equivalent to a quality treatment. Consistent results are easier to achieve when you establish a relationship with a given physician.
In this situation I, too, would ask the patient to return for a follow-up evaluation. More than likely I would retreat them. If I had taken pre-treatment photos I would compare them to the current muscle activity to see if there has been any improvement. If I did not have photos, I would take photos prior to the re-treatment so they were available for comparison if needed. I don’t know what the re-treatment policy of this spa is; but if they do not charge you for the re-treatment, then having it done seems worthwhile.
Very occasionally, a patient will return with concerns that the treatment didn’t work. More often than not, the treatment does provide some result, just not what was expected. I encountered something similar to this recently. I had a patient return after three weeks because of concerns that the BOTOX did not work. I was surprised to see that there was very little improvement; she had very good muscle function and mobility, so her result was no where near what I would have expected based on her previous relaxation. I had used the exact same dosing I did for her previous treatments. Unfortunately I could not explain why the BOTOX did not work. I re-treated her and she has done fine.
The duration of action of BOTOX Cosmetic and Dysport is 3 – 6 months, with the average being about 4 months; I find this holds true for my patients. In my experience it is not normal for patients to suddenly require more BOTOX in a given area of the face, after having achieved satisfactory results with a consistently smaller amount during previous treatment sessions.
When considering an individual patient, I find the majority who use BOTOX or Dysport achieve very nice and consistent results with the same amount (number of units) administered at regular treatment intervals. For example, for a patient that returns on a regular basis -- if he/she requires 25 units of BOTOX to treat the frown lines, that is about what is needed every treatment session.
I also find that the duration between treatments stays relatively constant for those individuals who seek to maintain consistent results. For example, for a patient who follows their muscle movement closely -- if he/she returns at four months because the frown lines are beginning to return, then he/ she is likely to return about every four months. In other words, the duration of action for a given patient remains relatively constant.
I hope you find this helpful.
Best Wishes. Ken Dembny