Permanent Paralysis w/ Long-Term Botox Use?

If botox is being used on a regular basis to paralyze the facial muscles, will it eventually cause permanent facial paralysis?

Doctor Answers 10

Effects of Botox are not permanent

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While it would very unusual for the muscle paralysis from Botox to be permanent, many patients have found that repeated, frequent Botox injections can give them a much longer favorable result that they are looking for.  While the effects of Botox usually last approximately three months in most cases, when injections are given in shorter intervals, after several injections, the effects can sometimes eventually last much longer. 

Bethesda Plastic Surgeon

Botox, Wrinkle Treatment, Beverly Hills Botox, Los Angeles Botox, Nasal Surgery, Beverly Hills Rhinoplasty

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No.  Permanent paralysis requires a permanent nerve injury or complete loss of muscle.  Botox injections cause a temporary weakening of the muscle (by blocking the nerve's signal to the muscle) while the nerve stays completely intact.  No matter how long you use Botox, the nerve still continues to send signals to the targeted muscle.  Stop the Botox and that signal gets through causing the muscle to contract.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Consistent botox treatment will not permanently paralyze the muscle

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Long term use of Botox injections will not permanently weaken or paralyze the muscles. The muscle activity will resume and with time, the effect will be as it was prior to the first treatment with Botox.

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

Can Botox make you as stiff as a surfboard, forever?

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Botox results tend to last longer and longer with repeated use.  If you cease Botox therapy, the normal musculature will return in time.  Some think that the brain may stop sending the message for those muscles to move, since these messages were ignored for so long.  I have heard some patients say that, so it may be true.  But it's really hard to do a study on that because of the long-term nature of the hypothesis.

Ritu Chopra, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

Botox results are temporary

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Botox results are temporary but with repeated, regular use you may get out of the habit of making certain facial expressions, such as a frown/scowl.  If the Botox does train you not to make that expression it might appear to last longer or you may not need as high a dose in the future, but it usually takes at least 1-2 years of continued use (without letting it wear off completely between treatments) and doesn't occur in everyone.

Lorrie Klein, MD
Laguna Niguel Dermatologic Surgeon
4.9 out of 5 stars 217 reviews

Permanent Paralysis with Long-Term Botox Use

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With the long- term use of Botox there may be some muscle atrophy which can decrease the strength of muscle movement and prolong the effect of the injections. However, I've never seen  permanent paralysis.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Can Botox Cause Permanent Paralysis

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All effects from Botox are temporary. With long term use the effects from Botox are commonly seen to become more prolonged, but are still not permanent.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.7 out of 5 stars 12 reviews

There is absolutely no permanent paralysis with BOTOX®.

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My personal belief that the muscle retraining thing is way over blown as well.  It is my experience that when post procedure results are spectacular, patients tend to come in before the treatment has worn off to renew treatment and it is actually typical that the effects of treatment last 4 to 6 months.  This is obviously not permanent paralysis.  BOTOX® is extremely safe as it is used to treatment cosmetic issues and is free of long term side effects.  It is for this reason it continues to be the most popular cosmetic treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Permanent paralysis with Botox

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Persistent use of Botox on a regular basis will weaken the muscle strength. This over time can soften the look of the muscle as well as the facial lines of animation.  Possibly eliminating the "etched line look." 

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

The relaxation caused by BOTOX® wears off after several months

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The relaxation caused by BOTOX® wears off after several months, but if you repeat the treatments when the relaxation starts to wear off, eventually your brain will make less of an effort to stimulate the treated muscles.

This accounts for the prolonged relaxation which some patients enjoy after they have been treated with BOTOX® on a regular basis for two or three years. These patients sometimes find that after several years of regular treatment they are able to go 4-6 months between treatments, instead of the 3-4 month treatment intervals that they started with.

Best wishes,

Kevin C. Smith MD FRCPC Niagara Falls Ontario

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon

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.