Weird botox results - results wearing off after 1 month. What can cause this? (Photos)

Question

I’m 33 years old. I have been getting Botox for about 7 years, about every 3-4 months for my forehead lines. I’ve been going to the same injector who owns as well known clinic in my city and I have always been so happy with her work. I have always gotten about 20 units in my forehead and included in that number was a few in my 11s, as I do not really have lines there. The past 1.5 years my results have not been good. After about 1 month after being injected I start to notice forehead lines and this weird curved line above my right brow. We have increased my dose to around 30 units and this still happens. Originally she thought she was under treating my 11s, so she added more there, still did not change. She is worried about adding too much to my forehead as I have naturally hooded eyes and she’s worried about my brow dropping. i havent had any lifestyle changes, other than trying adhd and anxiety medications. Please help! I got 33 units beginning of march 2026. After 2 weeks my forehead was flat. The picture is me today.

Laurie A. Casas, MD, FACS · Answer

Hi there! 
Dose can certainly play a role—since with neurotoxins, dose does correlate with duration—but in your situation this sounds less like a pure dosing issue and more related to how your muscles are activating over time.
After years of treatment, the forehead can develop compensatory movement patterns—especially if you naturally rely on it to lift hooded brows—leading to uneven reactivation as the Botox wears off, which can show up as that curved line above one brow. Increasing units alone doesn’t always correct this and can risk heaviness, so your injector’s caution makes sense. A more effective approach is usually adjusting the injection pattern and placement to better balance muscle activity, rather than continuing to increase the dose.
Hope this helps

Anna Chacon, MD, FAAD · Answer

This is frustrating, especially after years of good results.

Possible reasons:

Muscle strength changes over time
Metabolism differences
Injection pattern imbalance (that curved line suggests this)
Medication effects (your ADHD/anxiety meds can play a role indirectly)

Less common but possible:

Antibody formation (rare, but happens)

What I would adjust:

Injection pattern—not just dose
Consider switching toxin brand
Evaluate forehead vs glabella balance carefully

This is fixable—but it requires strategy, not just more units.

Kally Papantoniou, MD, FAAD · Answer

If it’s consistently wearing off around the one-month mark, that’s shorter than expected, but not unheard of.

The most common causes are dosing and placement. The “curved line” you’re describing often happens when certain parts of the forehead are still moving more than others, so it can be more of a pattern issue than just needing more units.

Metabolism can also play a role. Some people simply break down toxin faster over time. Medications don’t usually have a major impact, but it’s not impossible.

True resistance is pretty rare, especially if you’re still seeing a good effect at two weeks like you mentioned.

At that point, it’s less about just increasing the dose and more about adjusting how it’s placed. An in-person evaluation, possibly with a slightly different pattern or even a different neurotoxin, can help sort that out.

Camille Cash, MD · Answer

You may want to try to switch to a different neuromodulator for awhile and then go back to Botox.  Some patients do experience fatigue from these medications and switching them may bring back your expected results.  Some to consider are Dysport, Jeuveau, and Dysport.

Weird botox results - results wearing off after 1 month. What can cause this? (Photos)

Answers (4)

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