Botox and Xeomin are lasting only 4-6 weeks. Is there any specific reason this is happening?

Question

The first time I had Botox, it lasted about 3 months. The second time, it lasted about 6 weeks. I then gave up until a special for Xeomin was offered. It kicked in at 7 days and starting wearing off at 35 days. I basically got a month's worth for my money. My doctor suggested either changing the product to Dysport or increasing the amount above 20 units. Which suggestion appears to be the best route?

Lewis Albert Andres, MD · Answer

BoTox, and all forms of Botulinum Toxin A, work by blocking the reuptake of acetylcholine at the neuromuscular junction. By doing so, it inhibits transmission of signals from one neuron to the next at whichever junction it is working on (e.g., neuro junction, sweat gland junction, etc.) The duration of BoTox is typically 3-4 months on average. It can take up to 7 days for it to take effect. It is likely that you just need additional amount. Those with very active muscles often times require more BoTox for effect. Thank you for the question! Hope this helps!

Brian C. Reuben, MD · Answer

Thank you for your question.  The most common reason for Botox "wearing off" early is that not enough was used.  Botox is priced by the unit and there are "average" units used to treat areas.  Many patients will buy a package that has only a certain number of units or the "average" number of units are used and they do not get a reasonable or long lasting result.  You may be a person that needs a higher dose or more units to get a treatment effect.  This is not uncommon.  Switching to yet another product is rarely the answer.

Jason Emer, MD · Answer

The typical duration of effect is 3 months, but for some it is less and for others more.  If the dosage is too small at the onset, the duration will be less.  So either starting with a higher dose or trying another neurotoxin may be helpful in prolonging the effect.  I wish you the best of luck, Dr. Emer.

Timothy R. Miller, MD · Answer

The duration of effectiveness is less than typical for most patients having these treatments.  The duration should be in the 3 month range, in general.  There are rare cases where patients have developed antibodies (resistance) to Botox or similar products but this, again, is very rare.Often the top three possible reasons for a short duration are: 1.  Not enough units to the area of treatment (e.g., using only 10 units when you need 20 units.)2.  Inexperienced injector missing the muscle.3.  The product is not stored correctly.The link below discusses how Botox should be stored.I hope this helps.

Ran Y. Rubinstein, MD · Answer

To answer your question, which I am often asked by patients who have been seeing me for years but decided to try another provider after seeing a discount, I will enclose a recent newsletter I shared with my patients on this important topic.  Hope you find this to be helpful.What is Botox and how does it differ from Dysport or Xeomin?They are FDA approved toxinsused to treat unwanted facial expressions that cause lines and drooping.Botox is still the gold standard.Dysport and most recently Xeomin are competing products.Do they work as well?Last as long?Cost less?Botox typically lasts
3 to 6 months.If you have regular
treatments, it can last 4 to 6 months after two years.Dysport can be equally effective and last as
long as Botox but only if you prepare it in a much more concentrated manner
than it received its FDA approvals for.This negates any cost savings.Dysport can also spread out more locally, from
the injection site.This can have a
positive effect around the eyes but in the forehead can cause the brows to
droop.Xeomin has been disappointing as
I have found it to be completely worn off by 2 to 3 months.Yes, it costs a little less than Botox, but
to have half the duration of effect in my opinion makes it a more costly
treatment in the long run.Who can inject Botox?Until recently, only core physicians in the esthetic field
(plastic surgeons, facial plastic surgeons, dermatologists) were injecting patients with Botox and
fillers.Due to the changes in
healthcare and physician insurance reimbursements, non core physicians (i.e. gynecologists,
ophthalmologists dentists, cardiologists...) have increasingly turned to
services not covered by insurance such as Botox, injectable fillers and laser
treatments to boost their revenues.As
an experienced trainer, having trained 100's of physicians in the tri-state area,
I have found that clinical background, knowledge of facial anatomy, and cosmetic experience
is very important in learning proper injection techniques.This is however by no means the only
criteria.There also needs to be a
natural appreciation of what is youthful and beautiful.This I can't teach.Although core physicians have an advantage in
learning new cosmetic techniques, I have come across some naturally gifted non
core physicians and even nurse practitioners who I am confident went on to
offer their patients successful cosmetic treatments.Why do some places charge so much less for Botox?We have all seen ads that are
too good to be true.These prices maybe
a onetime offer to attract new patients.More likely however, the Botox has been watered down decreasing the
amounts of units you are receiving per area.Another cause is if the Botox has been sitting around for a while once
it has been mixed.This is more common
in practices that don't inject a lot of Botox.The worst scenario is if much less expensive fake Botox is being
used.Systemic complications and even
death has been reported from the use of fake Botox.More likely however, the results may not be
equivalent to the real thing.The way
one can find out if the Botox is fake is by asking to look at the expiration
date on the glass vial.It should match
the expiration date on the carton.The
vial also can say "For
Research Purposes Only, Not For Human Use" .The FDA recently sent out another warning
about rampant fake Botox and filler use and named physicians who were linked to
its use. This type of practice maybe more
common with non core physicians who may feel they have to make their pricing
more competitive, as well as spas and
hair salons who increasingly are offering injectable treatments.The spas will contract with a nurse or
physician and often share in the profits. For this to be profitable, they may have to
bring down the cost of their Botox.This
is done by watering it down or using fake Botox.I am hoping that greater consumer awareness
of this problem will lead to improved patient safety.Beware of "Botox parties".My personal opinion is that any plastic
surgeon that has to rely on a hair salon or spa for their Botox clients may not
have sufficient patient volume in their own practices.There may be a reason for that.Do your homework.Don't
be lured in by prices that are too good to be true.Ran Y. Rubinstein, MD
200 Stony Brook Court, Newburgh, New York 
Board Certified Facial Plastic Surgeon
Clinical Professor New York Presbyterian Hospital
National Education Faculty (physician trainer) for: 
  Allergan (Juvederm, Voluma), Valient (Scultpra,
Restylane), Cynosure (Cellulaze, Precision Laser Lift)
& Solta (Fraxel, Thermage)

Michele S. Green, MD · Answer

Often times patients tell me that they had Botox done in other offices but complain that it did not last. Often the reason is that the Botox was diluted too much to use less or Botox was not used but Xeomin or another substitute. For the best results please find a board certified dermatologist with a lot of experience with Botox or facial injections.

Seth Kates, MD · Answer

Generally Botox lasts at least three months and usually longer (especially in areas other than the eyes).  I frequently find that Xeomin lasts less long than Botox at equivalent doses.  20 units is generally enough for the frown, eyes, or forehead but not for all three.  I would make sure that you are getting the actual product and at an adequate dose for the treated area.  I wouldn't expect that Dysport would last longer than Botox.Good luck

James F. Farrell, MD (in memoriam) · Answer

While Botox Cosmetic is meant to last 2-4 months for most patients, if you changed your physicial activities this could have an effect.  Patients that exercise in a large amount such as personal trainers tend to break down Botox at a faster rate.  We have carried Dysport and Botox in our office and Botox always lasted longer than Dysport.  You also might want to try a different injector.

Botox and Xeomin are lasting only 4-6 weeks. Is there any specific reason this is happening?

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