What Happens when You Stop Routine Botox and Restylane?

Question

Just wondering what happens when a woman aged 65 stops her routine botox and restylane injections?

Ron Shelton, MD · Answer

If a patient decides not to continue the treatment with Botox or fillers, the skin will not return to a condition worse than when he or she started the treatments. In fact, many people retrain themselves not to contract the muscles with prolonged treatment of Botox, and as the habits are forgotten, and there is less squinting or less frowning, these lines may improve. Repeated fillers, whether with Restylane or Juvederm, Fat Injections, Radiesse, or other fillers, the trauma involved with the procedure and the inflammation during the wound healing, helps produce more of one's own collagen. Some people need less product when they return for more filler in the future because of this reason.

Mitchel Goldman, MD · Answer

Both Botox and Restylane require regular touch-ups to maintain their good results. If you stop Botox, after three to four months you may begin to see your wrinkles reappearing, as the dynamic muscles that form them go back to their normal activity. However, if you have been receiving Botox for many years, the muscles may be weaker than they were initially and you may have broken the ability for the brain to always activate the muscles. If you stop getting Restylane, after a year, the wrinkles will come back but they may never be as bad  as they were before you started treatment since all fillers also cause your body to make new collagen. As with all regimens – whether for weight loss, hair care, or skin-care – anti-aging routines must be maintained to continue their benefits. Please consult with a board-certified dermatologist to keep your face looking its best.

Michael A. Persky, MD · Answer

Hi,
When a woman 65 stops her rountine Botox and Restylane she goes through the dreaded "Botox-Restylane Withdrawal Syndrome".  Fortunately the withdrawal symptoms are mild and only experienced when looking in the mirror, or hearing fewer compliments on how great  you look. 
There are no medical consequences to stopping the treatments other that your injecting physician having to pay a little less tax (the proposed 5% "Botox" tax in the Health Care Bill currently before the Senate on all elective cosmetic treatments).
The symptoms of withdrawal are easily reversed with other non-invasive facial rejuvenation procedures.   
Good luck and be well.
Dr. P

Olivier Deigni, MD · Answer

Hello Jane and thank you for your question.
There are multiple approaches available to help counteract the effects of aging. These include but are not limited to good skin care regimen, avoidance of excessive sun exposure, applying sunscreen, use of neuromodulators and filler injections, laser resurfacing, surgery etc... The majority of patients who receive Botox and Restylane do so in order to reduce or eliminate facial wrinkles and improve their facial appearance. Typically, the effects of Botox will last on average about 3-4 months and the effects of Restylane will last on average about 6-9 months. Therefore, someone who has been getting routine Botox and Restylane injections and then stops getting these injections will begin to lose the effects of these treatments throughout the time frame as discussed. The effects of the natural process of aging will begin to be visible again and facial wrinkles and lines will appear over time.
Olivier A. Deigni, MD, MPH
Houston Plastic Surgeon

Melda A. Isaac, MD · Answer

Once you discontinue Botox and Restylane, the good results you achieved with these products will disappear over time. It takes about three to four months for Botox to be metabolized. At that time, the dynamic muscles will no longer be relaxed and can once again form wrinkles. Restylane takes about six to nine months to diminish. However, it may stimulate collagen production so that the benefits may last a bit longer than that. In short, your face will look much like it did before you began your rejuvenation regimen. Please consult with your board-certified dermatologist so that you can work out a plan that will allow you to keep up your more youthful appearance.

Bruce E. Katz, MD · Answer

When Botox and Restylane are stopped the aging process will certainly continue. The improvement that you have been working on will eventually start going away very gradually. You will start to see Botox diminish around 4 months and Restylane around 6 to 9 months.

Lee Kleiman, MD · Answer

When Botox and Restylane are stopped the person's wrinkles and folds will return to baseline especially if the usage was short term. Long term treatment of Botox can result in disuse atrophy of the muscles causing the wrinkles and those muscles may not come back full force. Repeated Restylane injections may cause an inflammatory response that causes fibrosis underlying the wrinkles resulting in a degree of permenant augmentation for some individuals. Of note, of the common fillers available, Restylane results in less of an inflammatory response.

William P. Coleman III, MD · Answer

Like stopping cutting your hair, if you stop using Botox, the effect will gradually go back to baseline. There is some evidence however that filler injections stimulate production of collagen, so some of the benefit, although slight, may persist.

Steven Wallach, MD · Answer

Once the botox is stopped, the muscle action will eventually come back and forehead lines and crow's feet will recur. As for the facial fillers, the lines will become more noticeable as the product resorbs.

Mary P. Lupo, MD · Answer

The improvement of the lines and folds will gradually go away. Depending on how long you were doing these procedures will determine if you look older quickly or slowly. Studies have shown a cumulative benefit over time if you have done the procedures for several years, so the longer you were doing it, the longer you will look better before you return to baseline. In fact, you likely will never look as bad as you would have if you had done nothing at all.

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