Botox - Are the Lines Supposed to Completely Disappear? AND my First Shot Lasted One Month

Thanks in for your time and courtesy on answering my questions. I had my first treatment of Botox for a line that goes across the bridge of my nose (between the eyes). My Dr gave me 2 quick shots of Botox on Dec 2. It is now January 11 and movement has returned in the area. Also, the line I wanted treated never disappeared. It was always there even after the Botox. How long does Botox last? What determines how long it will work for me? Should I be asking my Dr for a specific strength?

Doctor Answers 18

Botox - Factors to Consider

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After years of repeating the same facial expressions, eventually expression lines will form in these areas even when the expression itself is not being produced. The only way to help prevent these lines from appearing at rest is to apply Botox to the muscles which form the expression to soften their movement. However, there are many factors which contribute to the result of your Botox treatment.
When treating my patients with Botox, my goal is not to erase all of their lines, but rather to create a naturally smoother appearance. Botox is not capable of filling in lines as it is not a dermal filler, so it makes sense that your line did not disappear with Botox alone. The frown area between the eyebrows is a common area for a combination treatment of Botox to quiet the facial expression and a dermal filler (such as Restylane or Juvederm) to lift the line and create a smoother appearance.

Your treatment result depends on how much Botox is used, its placement (which muscles are injected as well as location within the muscle), the strength of the muscles treated, and the technique and expertise of your injector. On average, you can expect to repeat the treatment every four months to maintain your results. After repeated treatments at this interval, many patients will eventually notice a longer term effect as the muscles remain quiet over a longer period, and require less drug to suppress their activity.

The longevity of the dermal filler will also largely depend on the area injected and which product is used. When combined with Botox, I have found the filler to last longer, likely because the Botox is keeping the normally active muscles suppressed, so you are not “pushing out” the product through repetitive movement. In my experience when treating frown lines between the eyebrows, the filler does not require a touchup for at least one year (often times longer), particularly when used in combination with Botox that is maintained at regular intervals.

Vancouver Dermatologic Surgeon

Botox Duration and Line Disappearing

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Botox/Dysport  typically last 3-4 months in most patients.  Lines that are deep, from years of facial expression, do not typically disappear with one time injection.  They may soften over time with repeat injections, however they may never completely go away.  Sometimes, combining a Botox/Dysport treatment with a filler, such as Restylane or Juvederm can give you a better result.

Lisa Kates, MD
Annapolis Dermatologist

You might need a little more botox

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In this case, I would consider the following:

A. You may need a few more units of Botox

B. You may not have had the muscles that were causing the problem injected with the Botox (i.e. it was injected into a less effective place).

Hope this helps.

Cheryl Lee Eberting, MD
Salt Lake City Dermatologist

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Botox not lasting long enough

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Botox typically lasts 3-4 months, but I have seen it last longer in some patients. If you don't see any change after one month, then you should return to your injecting physician. It is likely that you were under-treated. You should be aware, however, that not all of the lines will 'erase' in many patients. If there are deep lines from years of activity, these may persist after a Botox treatment.

Ryan Greene, MD, PhD
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How Long Should My Botox Last?

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Hi SS.  In terms of how long your Botox should last, one month is definitely too little.  When properly dosed you should receive 3-4 months of benefit.

In regard to the line that was being treated.  It almost sounds by your description that the line is horizontal because you say it goes "across" the bridge of the nose.  Botox is primarily used to treat vertical lines between the eyes, but may still work if you have a horizontal line.  The other possibility is that you have a deeper vertical crease that may need some dermal filler to treat completely.  We use Restylane or Juvederm usually in this case.  See the pictures in the link below to see a female with a deep furrow line that required both Botox and dermal filler (4th set of pictures down).

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
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Botulinum toxin should last about 3 months - some lines require dermal filler to be eliminated

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Botulinum toxin should last about 3 months but every patient is different in terms of the number of units they require for good effect and the duration of effect. Botulinum toxin weakens muscles and softens lines created by muscle movement. It does not treat lines that are imprinted in the skin. These lines can require dermal filler to be eliminated. Sometimes botulinum toxin and dermal fillers are used simultaneously.


Stephen Weber MD, FACS

Botox and lines

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Botox cannot completely eradicate lines form muscle animation. Some of those lines are etched in form constant motion. They usually soften somewhat.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Some Limitations of Botox

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When treating the glabellar region, Botox does an excellent job minimizing/eliminating vertical lines. These are lines that form as a result of repetitive muscle contraction. There are individuals who have thick muscles in the glabellar region, especially centrally, and the weigt of the muscle is being pulled down by gravity. This causes a small horizontal line above the brige of the nose (between the eyes). Botox will unfortunately do little to eliminate this line in most cases. Even if more botox was applied, the mass of the muscle would be the same and gravity would continue to pull down on that muscle causing the line to persist.

Relief Jones, III, MD
San Antonio Ophthalmologist

Do Lines Always Disappear with Botox? No

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The dynamic lines which are created by years of activity in the brow area are not always eliminated by Botox.  Some patients have very deep lines which will be softened, while other patients have lines/creases which are effectively erased after treatment with Botox. Immobility of the forehead is possible with larger doses (number of units received) if desired. The average duration of Botox is about 3 months.  Generally, a short duration of Botox (1 month) is related to an inadequate dose  or handling issues with the Botox.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Botox and skin creases

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Skin creases may take a while to disappear as they were created over many years. If the crease is a static line, one that is there from sun damage not muscle movement, then it won't improve with botox injections. If the line is related to years of muscle contraction in that area, and if those muscles can safely be treated with botox injections without interfering with vital muscle function (such as muscles that allow us to smile and speak correctly) then that line may improve over time. Botox usually lasts three to four months as does Dysport.  You may need more units to get a longer duration of effect, but again, if it's not the glabellar muscles which make your skin crease on the nasal bridge, but the nasal muscles, then botox injections would have to be directed to a different area. It is possible though that working lower on the bridge of the nose and sides of the upper nose to accomplish this could interfere with the upper lip muscles.

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