Had 36 Units of Botox in Frown Lines and it Started Wearing Off After 3 Weeks, Normal?

There are three areas that Botox can be placed:  In the wrong muscle, in no muscle, and in the correct muscle. Only the last gives you a good result. I'd recommend seeing an injector with a large amount of experience with Botox, and a great understanding of the aesthetic field. You can usually find these specialists as board certified facial plastic surgeons, plastic surgeons, or even some dermatologists. Registered nurses directly associated with these types of specialists can be excellent as well. I'm confident you will be very happy with future treatments.

Andrew C. Campbell, M.D.

Board Certified Facial Plastic Surgeon

Milwaukee / Sheboygan, WI

Another advantage to seeing board certified dermatologists and plastic surgeons for  your botox of the frown lines is that there is a higher standard of providing care and ensuring that the Botox is only from U.S. Allergan sources, the Botox is diluted appropriately and that the Botox has not been allowed to sit for too many weeks after dilution.

Botox is an extremely common treatment in the United States with roughly 5,300,000 procedures performed in 2010 according to the ASPS.  Every injector probably administers the medication a little differently.  For moderate to severe frown lines, I typically start with 20 units total and make five separate injections each with 4 units.  It usually takes a day for the medication to start working and one week for it to have its final effect.  As a board certified plastic surgeon, I'm obviously a bit biased.  I don't see any reason for patients to seek treatment at spas when there are so many plastic surgeons around who administer Botox.  In your case, 36 units really does sound like a lot for treatment of frown lines, however it's hard to say without an exam.  It is possible that the medication was not reconstituted appropriately, it was too old to be used, or the medication was not administered correctly.

You probably got more water than botox.  36 units of botox is a pretty weird dose given how the vials are set up.  I think the spa may be pulling your leg regarding how much botox you are getting.  Small doses of botox wear off quickly.  Sometimes you get what you pay for.

It is important to seek an injector who is experienced and has good knowledge of facial anatomy.

I read your synopsis and several thoughts and questions came to mind – mainly those I would ask you if you were in my office with the same concerns. It sounds as if you have been satisfied with your previous BOTOX injections. Were you recently treated by the same injector that has treated you in the past? If not, why did you change? You know that you were treated with 36 units this last time. How many units have you typically received for previous frown line treatments? I don’t know your answers to these questions, but cheaper BOTOX is not equivalent to a quality treatment. Consistent results are easier to achieve when you establish a relationship with a given physician.

In this situation I, too, would ask the patient to return for a follow-up evaluation. More than likely I would retreat them. If I had taken pre-treatment photos I would compare them to the current muscle activity to see if there has been any improvement. If I did not have photos, I would take photos prior to the re-treatment so they were available for comparison if needed. I don’t know what the re-treatment policy of this spa is; but if they do not charge you for the re-treatment, then having it done seems worthwhile.

Very occasionally, a patient will return with concerns that the treatment didn’t work. More often than not, the treatment does provide some result, just not what was expected. I encountered something similar to this recently. I had a patient return after three weeks because of concerns that the BOTOX did not work. I was surprised to see that there was very little improvement; she had very good muscle function and mobility, so her result was no where near what I would have expected based on her previous relaxation. I had used the exact same dosing I did for her previous treatments. Unfortunately I could not explain why the BOTOX did not work. I re-treated her and she has done fine.

The duration of action of BOTOX Cosmetic and Dysport is 3 – 6 months, with the average being about 4 months; I find this holds true for my patients. In my experience it is not normal for patients to suddenly require more BOTOX in a given area of the face, after having achieved satisfactory results with a consistently smaller amount during previous treatment sessions.

When considering an individual patient, I find the majority who use BOTOX or Dysport achieve very nice and consistent results with the same amount (number of units) administered at regular treatment intervals. For example, for a patient that returns on a regular basis -- if he/she requires 25 units of BOTOX to treat the frown lines, that is about what is needed every treatment session.

I also find that the duration between treatments stays relatively constant for those individuals who seek to maintain consistent results. For example, for a patient who follows their muscle movement closely --  if he/she returns at four months because the frown lines are beginning to return, then he/ she is likely to return about every four months. In other words, the duration of action for a given patient remains relatively constant.

I hope you find this helpful.

Best Wishes. Ken Dembny

Thirty six units is a lot of Botox for the frown lines.  I don't want to impugn all spas but Botox injections are a medical procedure which in my opinion should be performed by a medical physician adequately trained in this field.  We cannot tell why 36 units are not working when it is more than an adequate dose.  Perhaps they are not being forthright with the amount of units you are receiving or perhaps you received Dysport and they are quoting you the number of Dyport units in which case this is a sub-optimal dose.  Bottom llne you should be receiving medical treatments, such as Botox from a licensed and well trained physician.

The first question is whether you had Botox from Allergan Corp and not a substitute or overly diluted formulation. When I hear spa,I do not assume that you were injected by a board certified plastic surgeon or dermatologist. If you were injected by someone without those credentials, it is possible that the injections were not properly placed. Rather than returning to the spa, I recommend that you see a well credentialed physician for evaluation.

Many factors contribute to the effectiveness of neurotoxin (Botox, Dysport or Xeomin) injections:


Experince of the MD doing the injections.

Where and how much (number of units) of the Botox, Dysport or Xeomin used.

How long has the neurotoxin been re-constituted.  If greater than 2-3 weeks, most experienced injectors believe the potency decreases.


I have used Botox (for over 20 years) and the other neurotoxins since they were approved here in the US and 36 units of Botox for the Glabellar area is double the standard dose.  While safe, 36 units should give you a noticeable result.  For maximum effect, I like to do a full re-treatment of the area at 1 month and then at 4-6 month intervals to maintain the resuts.