Botox does not last - how can I improve facial drooping? (Photos)

Question

I have had Botox and cheek filler. My Botox no longer lasts. It wears off in a month. For example, around the 18th of DEC MY DAO was injected. I hate my face. It seems unbalanced, my jowls and eyebrows droop. Not sure how many units I get, but I spend around 600 if they do the gabellum, masseter , DAO, crows, forhead and brow lift. What would you recommend ? See plastic surgeon vs med spa nurse? Different product vs Botox? Threads? Filler? Micro needling? No surgery .

Anna Chacon, MD, FAAD · Answer

I completely understand how frustrating this feels, especially when you’re investing time and money and not seeing the results you want. From your photos and description, it sounds like several things are contributing to what you’re noticing: the Botox wearing off quickly, volume loss in the midface, and natural tissue descent.

If Botox is wearing off in a month, it may be due to how your muscles are reacting, the dose, or even metabolism. Sometimes trying a different neuromodulator, like Dysport or Xeomin, or adjusting injection points and units can help the effect last longer.

Botox alone won’t lift tissues—it relaxes the muscles, and if there’s underlying sagging or volume loss, that can become more noticeable. Strategically placed fillers in the cheeks or midface can help support your tissues and improve balance. Threads can provide some lift for mild sagging, but results are temporary. Microneedling and skin tightening improve texture but don’t create lifting.

Choosing a provider with a deep understanding of facial anatomy makes a big difference. While skilled med spa injectors can do great work, sometimes the most predictable results come from board-certified dermatologists or plastic surgeons who do a lot of aesthetic facial work.

The best approach is usually a combination: longer-lasting neuromodulators, targeted fillers to support your midface, and possibly skin tightening if needed. This balances relaxation of overactive muscles with support for sagging tissue. I completely understand the frustration—it’s very common, and you’re not alone in feeling this way.

Raffy Karamanoukian, MD, FACS · Answer

Unlike other tightening treatments, Ultherapy only requires a single treatment every one to two years and has long-term effects in skin stimulation and collagen production. Ultherapy is ideal for men and women who are experiencing mild to moderate skin laxity and desire a noticeable and long-term skin tightening treatment without the complications and risks of more invasive surgical procedures. Ultherapy can be combined with dermal fillers, Botox treatments, chemical peels, skin tightening lasers, and skin facials. Our plastic surgery and cosmetic center in Santa Monica offers Ultherapy as a complement to other skin treatments and cosmetic rejuvenation procedures.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Botox does not last - how can I improve facial drooping? (Photos)

Answers (2)

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