Got a New Doctor Now Botox Doesn't Last As Long - What Gives?

Do some doctors dillute or "water-down" Botox? When I lived in Arizona, my old doctor stressed that his Botox was not diluted (my injections lasted about 5 months). I recently received injections from a reputable Austin plastic surgeon, and the Botox only lasted 2 months! What gives?

Doctor Answers 12

Botox not lasting as long

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It generally takes 3 to 5 days for Botox to work. Some individuals can take up to 14 days.  For most patients botox should be about 80% effective at 120 days.  Most patients report that it lasts up to 4 to 5 months.  There are many variables involved including the number of units injected, The location for the injections and  The technical skill of the injector.  If you are not getting these types of results you may want to go to another provider.  Some people just metabolize the product faster than others.

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

My Botox only Lasted 2 Months - What gives?

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The only way to know for sure what's going on is to figure out how much Botox was injected with each practitioner.  If you are having the same areas worked on either the second physician is not using as many units of Botox or he/she is not a good injector.

Start by asking for your medical records from both offices.  Compare the number of units used and then share your concerns with the second physician.  Good luck.

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

Botox effect is dependent on amount of units and injection method

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Each vial of Botox contains 100 units of Botox, which is in a powder form. Therefore, if one places one cc of solution in the bottle, a 1cc syringe (which is typically used) will contain ALL the Botox in the vial. However, injecting 100 units of Botox in one area is over-kill, and may produce an unnatural look.

For most areas of the upper face, 15-20 units will produce natural results which can last 3-6 months, depending on the patient. I typically use 5cc of solution to dilute the powder, so each 1cc syringe contains 20 units of Botox.

The method of injection and where to inject is also important. The Botox must be injected in the muscle to which weakness is desired.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

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Botulinum toxin preparation, dose and dilution

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Yes, dilution can be a factor in the longevity and effectiveness of the injection. Practitioners vary in their preparations and may add anywhere from 1 to 10 cc with the package insert advising administration of 2.5cc in order to achieve a concentration of 4 units per 0.1cc.

Discuss your resutls with your surgeon, I have coocationally seen variations in the effectiveness of different lots which I cannot explain even when the dilutions are prepared identically.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Length of Time Botox Lasts

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The likely explanation is that you were probably getting more units injected at your previous doctors office.

Botox has to be diluted or reconstituted in order to inject it as it is a powder. Different surgeons dilute the powder differently. But this does not change things if you get the same amount of units injected.

So it really comes down to units injected and not the volume injected. There is the possibility that the botox was sitting around for a prolonged period of time and may not have been that effective.

Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Botox not lasting as long with another doctor

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Botox comes in powder form in a vial. The physician must dilute it with some salline in order to inject it. The amount of saline that is used to dilute the Botox is different in different practices. The total number of units injected into an anatomical site is the most important variable that should be kept in mind. You might consider authorizing the first physician to send a copy of your record to the current treating physician so you can get the same number of units of Botox as you did in the past. You might then notice a longer duration of effectiveness.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox longevity

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Botox is always diluted to some degree. It must be reconstituted with some volume of saline (I use 2.5cc, others may use more or less). The variables are the number of units injected and the technique. I usually see Botox actually last longer with repeat injections. I, too, would suggest getting your next injection from a different practitioner.

John Whitt, MD (retired)
Louisville Plastic Surgeon

More Botox units last longer.

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The most likely explanation for your Botox result lasting only two months is that you  did not get enough units.  The other possibility is that the Botox was old, or not mixed properly. Try another plastic surgeon or dermatologist.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Got a new doctor now Botox doesn't last as long - What gives?

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It's not the Botox that's different, it's the doctor.  You are either getting fewer units of Botox, or the Botox is being injected incorrectly, in either case, sounds like it is time to find a different Botox gunslinger down there in Austin.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

Buyer beware when it comes to Botox

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Never be afraid or shy about asking pointed questions to a physician. Some doctors are not as reputable as others. Botox can be over-diluted to make you think you are getting a lot when, in fact, you are getting fewer units. If Botox sits, it looses potency. Expert, experienced Botox injectors go through several vials everyday, so you know your material is fresh. Botox works. It is the provider that I'd question.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

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.