I need help understanding how BOTOX "wears off"?

Question

If the original nerve sprout was not damaged, then why does the body grow the collateral sprouts? And how does the original one get re-established? I tried to watch a video and understand better, but would like if a doctor could explain a little better..........also, wouldn't the muscle work again after the collateral sprouts were established? Lastly, why would they retract when the original one "came back"? Sorry if any confusion, I just need to understand this better..........thanks so much.........

Theda C. Kontis, MD · Answer

This is going to be a bit technical-but here goes. In order to understand how Botox wears off, you first need to understand how it works.When a muscle is stimulated, the nerve ending releases a transmitter called Acetylcholine (ACh). The Ach stimulates muscle contraction. When Botox is injected, it is absorbed into the nerve endings and prevents the release of Ach. So, when you try to move the muscle, it does not contract. Botox is injected directly into specific muscles that cause the wrinkles that are being treated. Without contraction of the muscles, the wrinkles smooth out.Over the next few months, the nerve ending that has stopped working starts to send branches or "sprouts" to the muscle to start it working again. Once the nerve ending regains its full function again, the sprouts aren't needed and regress. The nerve ending at the muscle is now fully functional, at which point you will need more Botox.Now watch the videos again on YouTube and you will likely understand it better.

Martin Jugenburg, MD · Answer

Botox 'wears off' as your nerve endings regenerate the ability to release ACh to stimulate muscles.  Botox itself is long gone from your body by this time.

Scott Trimas, MD · Answer

The main way botox works is to block the release of a tiny chemical called acetycholine which stimulates the other end of the nerve ending to make the muscle contract. Over time new nerve endings are made by the cell that was originally blocked and a certain critical point is reached where enough new nerve endings produce enough chemical to make the other end of the nerve ending fire and stimulate the muscle to contract such as in frowning, smiling, etc.

Jason Emer, MD · Answer

Botox blocks the never transmitters that activates muscle contraction.  Overtime, the body breaks down the Botox and the muscle creates new small connections to the nerve so that the muscle can function again.  If you continue to inject new/more Botox, the muscle will not contract depsite new small nerve connections.  This can be beneficial for people who want no movement (ie no wrinkles) over time, as less dose is needed if you retreat before it wears off.  Hope this helped.  Best, Dr. Emer.

Sean R. Weiss, MD, FACS · Answer

Botox molecules bind the nerve ending in a way that is irreversible and prevents it from releasing the chemical signal that tells the muscle to contract.  To overcome this the nerve must grow new nerve endings that can release the chemical signal for the muscles to work.  It takes an average of 3 months for the nerves going to the muscles of the face to do this.

Richard Baxter, MD · Answer

Simply put, Botox and other neuromodulators such as Dysport and Xeomin disrupt the connection between muscle cells and the nerves that control the muscle. The body has a remarkable ability to re-build these connections, and for facial muscles this healing process takes about 3-4 months. That is also why there is no version of Botox that lasts longer; it isn't the duration of effect of the product, it is the body's healing time that determines how long the effect lasts.

David P. Rapaport, MD, FACS · Answer

Hello,

Thank you for your question. Botulinum toxin does not function by damaging nerves. It works by blocking the release of acetylcholine from your nerves to your muscle through the inhibition of a protein called SNAP-25, which thus inhibits muscle contraction. This is what gives a "relaxing" effect on your forehead, between your eyebrows, etc. - your muscle essentially is no longer contracting. This lack of contraction is what contributes to the prevention of forming wrinkles.

I wish you the best of luck in your journey, and I hope this has helped to address your question.

Alfonso Gonzalez Cepeda, MD · Answer

Botox works by blocking the signals from the nerves to the muscles. It essentially paralyzes specific muscles preventing them from contracting which causes wrinkles. The wrinkles then relax and soften.  The body knows how to mend the blocked connection and within 3 to 4 months, wrinkles slowly come back.

I need help understanding how BOTOX "wears off"?

Answers (8)

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