Botox and juvederm wearing off too quickly?

Question

I am 29 years old, frequently get Botox and juvederm but the effects of both only last about 4 weeks! I usually get 70 units of Botox, which is what my 55 year old mother gets (and it lasts forever on her!) And I get 2 syringes of juvederm in the lips... so I know I'm not under dosing! Is there any reason this is happening? I go to different plastic surgeons every time just in case it's a technique issue, but always same results.

James Bonaparte, MD, MSc, FRCSC · Answer

The important thing about Botox and Fillers, is that we all respond differently to them. I recently conducted a large research study looking at the duration of the different types of medications used to reduce wrinkles and you can see, that there is a range of differences.  This study looked at Botox, Dysport and Xeomin and was published in the prestigious journal, Plastic and Reconstructive Surgery. I included a link below to this article. Dr James BonaparteHead and Neck SurgeryFacial Plastic and Reconstructive SurgeryOttawa, Ontario, Canada

James M. Ridgway, MD, FACS · Answer

Dear geordie604,The question you ask is a very good one.  If you're going to multiple providers and receiving high quantity of Botox with only one month of results (and we are working with the assumption that all techniques, dilutions and quality of the neuromodulator are not an issue) then there are 2 main possibilities.  The first possibility is that you're developing an immune response to the Botox.  If this was the case you would not have much of a response as you're immune system would inactivate the toxin (one month would be too long of a result).  The second possibility is your interpretation of any motion being the loss of Botox versus normal facial compensation due to changes in facial motion, or lack thereof.  With regard to the filler, it entirely depends on what kind of fillers been placed into your lips as some last longer than others, but all should last at least 6 months.  More modern products, such as Volbella, retain volume longer while also maintaining a natural feel.  I hope this is helpful to you.Be healthy and be well,
James M. Ridgway, MD, FACS
Bellevue & Seattle Facial Plastic Surgeon

Kenneth D. Steinsapir, MD · Answer

Neutralizing antibodies occur to to botox but not typically for the does that are used with Botox.  It is more likely you are equating the maximum loss of muscle movement with treatment effect and you interpret any movement as the service wearing off.  Treatment is not about paralysis.  It is about shaping.  Just in case, try a treatment with Xeomin as an alternative.  There are cases of immunity to botox that then respond to Xeomin.  The juvederm is a smooth filler.  It does not hold in place.  That product is still there filling up the area around the lip.  I would be very interested to see your photograph.  Your probably need this migrated filler removed.

Aldo Guerra, MD · Answer

Thanks for your question. I'm sorry this keeps happening to you. I believe an alternative HA and neuromodulator may give you longer lasting results. Considering Dysport and Restylane products for the lips like Silk. These might be some options and similar risk profiles. Speak with your injector or seek a second opinion. Best, Dr. ALDO

Jason Emer, MD · Answer

It's rare, but some people are fast metabolizers. Xeomin or Dysport are good alternatives to botox. Volbella is a longer lasting alternative for the lips. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Hardik Soni, MD · Answer

Thank you for your question. Some patients do build up a tolerance to Botox. You can try switching to Dysport or Xeonim. Also, some patients tend to metabolize hyaluronic acid fillers quickly. It is unknown why this happens. I suggest trying another filler, such as Volbella or Restylane. Always remember to see an expert injector.

Shaun Patel, MD · Answer

Since you have tried different plastic surgeons and are getting the same results, the cause is probably not related to dosing, concentration or technique. Although it's rare, you are probably one of people who hypermetabolizes Botox and fillers. You can try Dysport or Xeomin as alternatives to Botox to see if they give you longer duration. Volbella is also a good alternative to Juvederm to see if you get longer duration of action. Hope this helps.

Reza Tirgari, MD · Answer

Typically we see Botox lasting the standard 3-4 months, and sometimes longer. However, as long as an appropriate amount is used by a reputable practitioner, it may be that you are developing 'tolerance' to the Botox or are simply a rapid metabolizer. We have seen these folks and the first solution may be to increase the dose.

Alternative products such as Xeomin and Dysport are also Botulinum type-A and will likely have the same result.

Alternative products such as Xeomin and Dysport are also Botulinum type-A and will likely have the same result.

Steven F. Weiner, MD · Answer

It seems like dosing and technique are not an issue. I boils down to some people are just hypermetabolizers of fillers and Botox. Sometimes I see this is people that work out more than the average person. I do see that over time, the lip fillers tend to last longer. If you haven't tried Dysport, I would try that. Xeomin is another option as well. Maybe Volbella will last longer in the lips but there is increased risk for nodules with it.

Karthik Ram, MRCS, DNB · Answer

Hi  good to answer your question.once you start seeing more muscle movement or more lines it indicates your botox is wearing off.may be due to repeated injection you had developed antibodies to the toxin .hence do plan your injection well ahead before the muscle recover fully.switch on to alternative after seeking help from your provider. to get long lasting benefit.

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