Ask any provider how long Botox lasts, and 99.99% of the time, you’ll get the same standard answer: three to four months. (It’s part of the reason newbie neurotoxin Daxxify got so much coverage when it launched, claiming a six-month duration.) So for most people, Botox or other neurotoxin injections tend to be done three or four times per year, give or take. But if it feels like your regular cadence has suddenly changed—and you’re finding that the effects of your injections are wearing off much faster than usual—what gives? Or if you do Botox as a first-timer, excited to be wrinkle-free for a few months, only to start seeing lines come back much sooner, why could that be? Here are five of the most common reasons your Botox might not be lasting as long as you want it to.
You may have developed somewhat of an immunity
While all the brand-name neurotoxins out there (Botox, Dysport, Jeuveau, Xeomin, Daxxify) utilize botulinum toxin A, there are differences when it comes to what else is in the mix. The first three contain stabilizing proteins, Daxxify is made with a peptide, and Xeomin has no proteins. In other words, there are some subtle nuances among them. (It’s why, even though the mechanism of action is the same across the board, you’ll often hear both people and providers proclaim their loyalty or preference to one over the others.)
When people start to feel like their injections are wearing off too quickly, the leading thought is that they’ve developed some type of neutralizing antibodies—not to the botulinum toxin itself but to these other components, explains New York City board-certified dermatologist Dr. Dan Belkin. He adds that this tends to happen in people who’ve been getting the same brand-name neurotoxin regularly for many years. Point being, if you’ve been loyal to one particular type of neurotoxin, switching things up may be a good option. The first line of action when someone complains about their results not lasting is to switch to a different brand name, says Dr. Babak Azizzadeh, a board-certified facial plastic surgeon in Beverly Hills, California. It very well could be that this alone is enough to achieve the more lasting duration you’re after.
You have a fast metabolism
While a fast metabolism has historically been highly coveted (the whole “eat whatever and never gain a pound” shtick), it may be less than ideal for neurotoxin results. While there’s no hard-and-fast scientific evidence backing the concept, the experts we spoke with agree that, at least anecdotally, there definitely are people for whom Botox and fillers don’t last as long. “They tend to be thin, with low body fat, and will often say that they ‘burn things off’ quickly,” notes Dr. Usha Rajagopal, a board-certified plastic surgeon in San Francisco. Dr. Azizzadeh agrees, adding that he tends to see this with long-distance runners in particular. Theoretically, this patient population is simply metabolizing and breaking down the neurotoxin faster.
You weren’t properly injected
According to Dr. Rajagopal, something as simple as not having enough neurotoxin injected is often a main contributing factor to its decreased longevity. However, it’s fairly easy to determine if this is the culprit. “With Botox in particular, the results are pretty much set at the two-week mark. Assessing how it has kicked in at this point is a good way to determine what’s causing the lack of longevity,” she says. In other words, if you’re still seeing unwanted muscle movement two weeks post-injections, it’s highly likely that enough of the neurotoxin wasn’t used. But if your results are great at two weeks and then drastically diminish by eight weeks, something else may be going on, such as the aforementioned antibodies, she points out.
To be fair, if you’re after more subtle results in general—and want to preserve a little movement—your results aren’t going to last as long as for someone who prefers a more dramatic effect, Dr. Belkin points out. He also notes that exact dosing isn’t directly comparable from brand to brand. It’s fairly comparable for Botox, Xeomin, and Jeuveau, but Dysport and Daxify have a different unit system, he notes. (In other words, if you’re switching up your brand, you may also need to switch up the amount.)
COVID-19 played a role… maybe
Here’s where our experts were split. While in the early days of the COVID-19 vaccines there were some documented cases of swelling after filler injections, the link between the effect of either the virus and/or the vaccine on neurotoxin has yet to be firmly established. To that point, Dr. Azizzadeh and Dr. Rajagopal say they haven’t seen any association between COVID-19 and neurotoxins. But Dr. Belkin disagrees, noting that he’s seen an increased number of people complaining about their Botox not lasting as long in the post-COVID era. His hypothesis and speculation? The way the vaccine ramps up the body’s immune response may, in turn, increase the production of those neutralizing antibodies.
It’s a matter of perception
Another possibility is that your Botox actually is lasting as long as it always has—you just think it isn’t. According to Dr. Belkin, that’s simply due to the way your skin ages and how that shifts the perception of how your Botox is acting. “You may have felt like you got a solid four months of results in your 30s but feel like that time frame is shortened by the time you’re in your 40s. The Botox is working exactly the same way on the muscles, but as your skin loses elasticity and firmness, you’ll start to perceive that it isn’t getting rid of wrinkles the way it used to,” he explains.
