Dysport & Botox Only Lasting a Month, Why Is That?

I had Botox injections for crows feet and it only lasted a month. My Dr then suggested I use Dysport, so I did, and that only lasted a month. Any suggestions on why the product is not lasting that long? I'm paying $310 a month for the Botox, and if I do the Dysport, I'm paying $290. I thought these products were supposed to last at least six months? Please advise. Thanks so much for your time and attention.

Doctor Answers 14

When Botox does not last long

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In most instances, Botox usually lasts 3 to 4 months on average, while it may last up to 6 months in some patients. There are several reasons that the product may not last including:

  •  Too few Units were injected. For reference, on average 25 units are used for the frown lines. As different physicians use different dilutions (how they mix the product), 0.5cc from one physician may equal 25 units and 0.5cc from another may equal 15 units. Therefore, we meausre in units not cc or mL. The amount of units needed for an effect varies from person to person, and men often need more units per treatment area than woman.
  • Improper injection. The Botox may have been injected partially into a blood vessel or it did not get to the muscle where it acts because of poor injection technique or due to over-dilution of the product (more cc of saline used in a vial yielding fewer units per cc)
  • Partially inactivated/stored product. Botox is not incredibly stable and can be theortically inactivated by aggressive mixing, the longer it is stored, or if not refrigerated.
  • Antibodies. Some patients do make antibodies to the Botox toxin, which will negate the effects of the product. This is not common and may occur after many treatment sessions.
  • Bruising.  Teoretically, bruising (the collection of blood under the skin) can dilute the Botox or carry it away from where it need to act. This may lessen the overall effect of the product, although this is not typically seen and would be localized.

For most patients, the next step is to try again with a freshly mixed vial of Botox. If one has the same short effect, then more units would be tried.

Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Botox not lasting long enough

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The most common reason for the Botox to not be lasting long enough is that too low a dose is being injected - the dosing depends on your age and strength of your particular muscles, and is best ascertained by a cosmetic expert such as a dermatologist or plastic surgeon. If you overuse muscles such as by smoking or through heavy weight lifting, Botox will also likely last less time. Botox typically lasts 3-4 months, with some patients getting 5-6 months duration. In a small percentage of patients, there are antibodies against Botox or Dysport which results in the Botox wearing out more quickly. You may also benefit from the addition of a filler in the treatment area.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Botox vs dysport

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Both Botox and Dysport are botulinum toxin. As such they block nerve endings and therefore the affected muscle group can't fire. Both products are reported to last2-6 months. Everyone is different. I even had a patient in whom no effect was seen. Be sure you are getting enough in terms of units per area. Your stated price seems a little high for the south bay

David A. Bray, Sr., MD
Los Angeles Facial Plastic Surgeon

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Dysport/Botox - Dysport & Botox Only Lasting a Month, Why Is That?

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It’s all about the Units!  There are exactly two questions that need to be asked when considering a Botox/Dysport treatment:  How many Units, and how old is the solution (ie, when was it reconstituted or “made up”)?

By now, everyone has heard of Botox but there is a lot to discuss and, despite its popularity, there are still some misconceptions about what it does - and what it doesn’t do.  Both Botox (Allergan) and Dysport (Medicis) are formulations of Botulinum toxin A, a preparation which was found serendipitously to be highly effective in diminishing the appearance of lines on the face and neck.  In fact, Botox and Dysport are among the most remarkable treatments available.  They work by temporarily weakening specific muscles of the face and neck and, as a result, they diminish the appearance of the lines and creases that form when those muscles contract.

The most common areas of the face on which Botox and Dysport are used are (a) the deep creases between the eyes (the glabella), (b) the horizontal forehead creases, and (c) the smile lines at the sides of the eyes.  Depending on where and how much is injected, they can also provide a moderate but effective elevation of the eyebrows.  They are also used, in smaller amounts, on many other parts for the face and neck, including the vertical lines on the upper and lower lips, the chin, and the banding on the neck.  Treatments diminish the lines that form when the muscles are contracted, and they soften the lines that are present at rest.

Botox and Dysport are administered by a wide variety of practitioners, including doctors (such as plastic surgeons, dermatologists, and ophthalmologists, among others), nurses in doctors’ offices (in some states), and non-medical personnel in some spas and similar settings.  It is important to know who will be administering the Botox or Dysport.  While it is not exceedingly difficult to give these injections there is, as always, a range of capabilities among the people giving them.

The injections take about 20-30 minutes (longer if topical anesthetics are used, in which case an additional 20-30 minutes is required for maximum effectiveness).  Via a series of injections with a fine needle, the Botox or Dysport is delivered directly into the target muscles.  The effects typically become apparent within 2-5 days, with the smaller muscles (like the smile lines) being affected first and the larger muscles (the glabella) taking a little longer.  The effects usually last for about 4-9 months, at which time additional Botox or Dysport can be given.

Both Botox and Dysport are marketed as freeze-dried precipitates (powders) that are reconstituted (made into a liquid form) by adding variable amounts of a salt-water solution that approximates normal body fluids.  Dosages of both are referred to as “Units.”  Botox is available in vials of 50 and 100 Units; Dysport is available in vials of 300 Units.  While there’s no absolute formula, about 2–2.5 Units of Dysport is equivalent to 1 Unit of Botox.

The keys to the effectiveness of these treatments are (1) How many Units are injected into each area and in total, and (2) How old is the reconstituted solution?

Number of Units:  The amount of Botox and Dysport to be administered depends on which area(s) the patient wants treated and how deep the lines are (which is related to how thick the muscles are – men typically have thicker muscles than women do), combined with practical considerations, including the costs.  Most people need at least 50 Units of Botox (100-125 Units of Dysport) to have the three major areas treated.

Typical distribution of Botox, then, is about 20 Units to the glabella, 20 Units to the forehead, and 10 Units to smile lines next to the eyes.  For larger muscles (and in men) increased dosages are required to achieve similar results.  Depending on the patient’s preferences, the distribution can be modified.  Since different amounts of solution can be used to reconstitute the product, the only thing that matters is the number of Units being injected:  not the number of cc’s (the volume of injected material), the number of syringes, or the number of injections.

Hold Old is the Solution?:  While most people may assume that the Botox or Dysport is being made up fresh for each patient, that is not necessarily be the case.  Though studies have shown that reconstituted Botox and Dysport can retain their effectiveness for up to several weeks, the package inserts suggest a much shorter duration (in the range of hours, not weeks).  My policy is to use product only within the recommended time periods.  Furthermore, unless other arrangements have been made, I make it up fresh for each patient or treatment.

The cost of these treatments varies widely, but typically range from about $500.00 to $1500.00.  Among the factors that determine the cost are the areas being treated, the dosages – and the doctor. 

When considering Botox or Dysport, it is important to know which product is being used, how many Units are going to be administered, and how old the solution is.  Without knowing all of these, accurate comparisons regarding the effectiveness and the cost of the treatments cannot truly be made.

I hope that this helps, and good luck,

Dr. E


Crows feet treatment

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The controllable factors that effect the duration of a neuromodulator such as Botox or Dysport are the strength of the solution, muscle density and accurate injection of the target muscle. I have found that the Dyport to Botox unit conversion is about 3 units of Dysport to 1 unit of Botox. I reconstitute both to the same effective strength with 2.5 cc of sterile normal saline (Botox comes in 100U vials and Dysport in 300 units) and that way I get the same effect from both. I do not see a difference in effectiveness between the two products with that dilution. I suggest using a 30 or 31g insulin needle on 0.5 or 0.3cc syring for the most comfortable and efficient injection. Also, the crows feet muscle is immediately under the skin and a small 2-3 unit injection bleb about 1-2 cm lateral to the orbital rim produces the most efficient injection. If the injection is too deep, much of the solution is dispersed and not picked up by the targetted muscle and the duration of effect may be shortened. I usually recommend 6-8 units of Botox or 18-24 units of Dysport per side for Crows feet treatment every 4 months. You can use a more concetrated solution but you have to be very careful with your injection depth and volume as it could cause ptosis or even incomplete eye closure. Also icing 5-10 minutes before and after the injections help keep the solution from being carried away from the targetted muscle by the dialated vessels in the immediate post-injection period thus decreasing the effective treatment dose and the duration of muscle relaxation. The icing also improves tolerance of the injection.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Botox & Dysport

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The mode of action is identical for both product . Both block muscle function. Every person is different and can get different results. Because of that I have had people who have had a 1-2 month effect while the usual is 4-6 months in my hands. I think the unit concentration is important. Also I have had better luck with botox then with dysport.  I have noticed that Dysport needs more units to get the same affect . 

Paul Albear, MD
Tampa Plastic Surgeon

Dysport and Botox not working

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  I agree that the duration of the effect of these agents are dose dependent.  Not all Crow's feet are the same and here in Florida I can see patients with VERY extensive (long) and deep rhytids (wrinkles).  I believe that most patients require AT LEAST 10-15 units per side depending of the severity of the problem.  So yes.  You might not be getting enough units injected.  This is something that only your doctor can answer.  Ask him and/or consider seeking out another provider.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

Botox and Dysport are Measured in Units

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With both Botox and Dysport lasting only one month, it is most likely you did not receive enough botulinum toxin to make the treatment last. The only way to know how much you were given would be to know the number of units that were injected. Knowing the price alone will not give you this information. I typically start at six to eight units of Botox per side and then increase the dosage as necessary, depending upon the response. I charge $10 per unit of Botox so a typical treatment for crow's feet is $160.


Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

Much of this is dose dependent.

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Dysport and BOTOX last about 4 month max.  In my experience, if you have a spectacular result from these services, you will begin thinking about getting more treatment as soon as the maximum treatment effect begins to soften which is about 2 1/2 months.  When a service disappears faster than this, it is generally because not enough treatment was used to begin with.  BOTOX and Dysport are not bioequivalent and they are not biosimilar.  This means that your treating doctor has to experiment a bit to learn what dose to use with the Dysport to get a treatment effect that is similar to what you experience with BOTOX.  It is not as simple as applying a conversion factor and saying OK, she was good with 10 units of BOTOX so she needs 2.7X10=27 units of Dysport.  It is likely that your treating doctor in an abundance of caution did not use enough Dysport on your last treatment.

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

Dysport and Botox only lasting a month

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There are various reasons why Dysport or Botox might last a shorter period of time in some individuals. These reasons include injection technique issues, storing the product for a long period of time, improper dilution of the product, antibodies, individual metabolism, and inadequate units.

The most common reason would probably be using an inadequate number of units for the particular individual. Each individual is unique, and while many injectors have a relatively standard routine number of units for each product in a given area, some individuals may require more or less units.  

In most cases, the product (either Dysport or Botox) will last 3-4 months, not 6 months.

All the best,

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.