Can Anyone Tell Me Why 12 Units of Botox in my Frontalis Takes Effect Within 20 Minutes?

I have had botox in my frontalis muscles 3x. Approximately 20 minutes after each time, my frontalis muscles are paralyzed. The prescribing information indicates effect takes 3+ days on average. I am of Basque origin, a population that has a higher than normal rate of pseudocholinesterase deficiency (PD). Could this be the reason even though botox mechanism of action is presynaptic and the literature that I found speaks to PD complications occurring w drugs that act @ the neuromuscular junction?

Doctor Answers 10

Botox quick onset

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You have a very interesting question. I asked some scientists and do not have any better understanding as to what would explain your quick action of onset. This would be a wonderful issue for the company, Allergan, to explore.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

BOTOX is variable

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BOTOX is variable.  Usually it does not respond in 20 minutes.  Usually it takes 24-48 hours, but there may also be a placebo effect which can cause it to feel like it works in 20 minutes.  That’s not to say that the experience is psychological, but the placebo effect does affect the body without the patient even knowing it. 

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

How Long does Botox take to Work?

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Hi Sayaah.  While we can't say why this is happening for you, it is very unusual.  We have never had a patient tell us that they experienced full onset of Botox results within 20 minutes.  Normally 1-2 days is typical and we don't do a checkup for first time patients unless at least 2 weeks has passed.

In any case, if you are experiencing very rapid onset, that just means your product lasts longer!

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox works within 20 minutes after forehead is injected

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 I have used Botox for over 20 years and your story is not in any way unusal, IMHO.  Many, of my Botox patients, display immediate results from the Botox but the clinical studies that Botox performed indicated that regardless, the effects peak between 4-7 days after the injection.  I would not read naything into your experience which seems within the normal response range.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Quick onset of botox

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While the package instructions give a time frame many patients have a quicker response and onset usually 24 hours not twenty minutes. This may be a result from trauma of the injection alone and not a factor of the botox. Difficult to say however my sentiments are the same enjoy the results. Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Can Anyone Tell Me Why 12 Units of Botox in my Frontalis Takes Effect Within 20 Minutes?

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You are so lucky for rapid onset. My question is longevity of the Botox in you? Maybe have a blood relative have some Botox to see if there is a genetic reason. 

Rapid botox

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Pretty remarkable. some would say not chemically possible. Perhaps the trauma of the injection contributes in your case. No matter, enjoy the instant result.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

20 min botox onset

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it would be interesting to do a sham injection with saline to see if the act of injecting (trauma) contributes to the effect. also does it last as long? longer? shorter? curious though. r u using allergan botox? could the doses be off? check the product , make sure you are not getting research strenght botox. in florida 4 people nearly died injecting super strong research grade botulinum toxin. I think they had a very short onset and a toxicity that lasted months.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Rapid onset of action

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You are definitely unique and that is a good thing!  Don't worry about  the rapid onset...but enjoy it.  The average time to onset is definitely around 3-4 days...but there are those with quicker induction.  20 minutes may be a record but it will do you no harm.  Hopefully, the lasting effects of Botox will benefit you for years to come.  Cheers.  Dr. Shep

Shepherd G. Pryor, MD
Scottsdale Facial Plastic Surgeon
4.6 out of 5 stars 23 reviews

Rapid onset of action of BOTOX

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There is no good reason for your very rapid onset. Everyone is different, and the information given in the inserts is generalized for the majority of people. I would say you are lucky: enjoy BOTOX's effects for as long as you can!

Barry Resnik, MD
Miami Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.