Why Did my Botox Only Last Two Months in Forehead?

I suggest you return to your injector and consider getting a more units administered. They may not have given you enough. however, please note that some areas may see longer lasting improvement than others.

I have considerable experience using Botox for aesthetic purposes, having started doing so in 1991, eleven years prior to its official FDA-approval for this purpose. Throughout that time, from time to time, I have encountered individuals who had at first responded well to treatment, but who, after two or more prior treatments, demonstrated either no response, weaker response or shorter duration of response.

The medical literature estimates the development of antibodies in the range of 3%-13%. However, it seems that  even among those with proven antibody formation few actually demonstrate any significant loss of responsivity to further treatments. This of course does not rule out that some may indeed do so and this fits my own experience in twenty-one years of injecting Botox for dynamic wrinkles.

An increased chance for promoting antibody formation may also be related to the routine practice of bringing patients back after just two weeks to touch up any areas that may not have completely responded to treatment. For this reason, it is currently deemed wiser to bring patients back no sooner than a month following treatment for touch ups.

When there exists no other obvious explanation for loss of response or shortening of duration of response (such as changes in dosing or concentration, etc.), and antibody formation is suspected, a trial of Xeomin, another bolulinum neuromodulator would be reasonable. Xeomin is essentially a naked  Botox, stripped of the proteins that come attached to Botox that are believed responsible for triggering the development of antibodies. I have found Xeomin to helpful among the few patients I have had recently  in whom I have suspected antibody-related resistance, In such instances I have seen full responsivity restored.

 

 

Not all treatments last the same, even with the same provider. I have noticed that using the same number of units in the same areas of my same patient, that usually their effect is the same in duration but occasionally a patient gets less duration. There may be other factors involved of which we're not aware. The company's insert indicates 8 to 12 weeks duration is the norm but clinically we hope up to four months. So two to two and a half months is not abnormal.

There is a clinical correlation between dose and duration of botulinum toxin (Botox, Dysport, Xeomin) up to a point.  This means that the effect of a very tiny dose of botulinum toxin is usually diminished well before the effects of large doses.  Once a certain dose is reached, administering more drug does not increase duration further.  The actual duration of effect will vary from patient to patient.

Typically botox lasts about four months, however, sometimes it may not last as long. I have found that if it wears off between injections a touch-up can enhance the results and can it help it last the expected time.

Being that you are reporting good outcomes and expected duration for the eye area, it would seem that your forehead did not receive enough product.  Another factor is placement of the injections.  Being that the forehead muscle is one, broad muscle, technique, dosing, and spread are important factors in order to maintain a minimum of three months duration. 

Most consistent users will report a longer duration and/or less product required as with future treatments.

We recommend expressing your concern to your injector so that he/she may revise your "recipe."

You may need more product, more injection sites in the forehead, or you may have very active, strong forehead muscles. Speak with your physician about how you could make it last longer next time. 

The duration of the effects of Botox differs in different sites, so not all areas will be on the same schedule.  Smaller amounts of Botox are usually injected into the forehead than into the crow's feet to prevent lowering of the brow.  It is better to repeat the forehead treatment and keep your brow up than to use too much Botox and possibly have a low brow for 4 months. 

Greetings~

The length of time that Botox can last can vary greatly between patients as well as different areas on the same patient.  The forehead is an area that most injectors would prefer to under treat rather than over treat to avoid any possible side effects of brow heaviness or droopy brow or eyelids.  Unfortunately, when different areas wear off at different rates it doesn't fit in to our busy schedules and lives.  We want all of the areas we treat to ideally be on the same schedule but that isn't always the case.  Discuss your experience with your injector so they can figure out if adding a bit more on your next treatment is an option.

Good luck~

Dr. Grant Stevens 

Botox effects do wear off and by 4 months it is usually needed again. Many patients I see have some fucntion resturn in 2-3 months and I encourage them to keep up with treatment so the lines do not get too deep.