Botox to forehead & masseter lasting for more than 8 months, is this normal?

Question

I have done a Botox treatment in my forehead and masseter and I heard the effect should be completely gone by 6 months, now it's been 8 months , the effect has reduced but I can't use those muscles as before as the Botox impact is still so powerful, so difficult to raise my eyebrows or do the 11 is this normal? Also my forehead and eyebrows never look the same as before and the same for my lower face it still appear sunken. What should I do? Please I’m so anxious

Anna Chacon, MD, FAAD · Answer

Thank you for your question — it’s completely understandable to feel anxious when the effects of a treatment last longer than expected, especially when it impacts facial movement or appearance.

Is It Normal for Botox to Last More Than 8 Months?
While the typical duration of Botox is 3 to 6 months, some individuals can experience effects lasting 7–9 months or even longer, especially:

If higher doses were used (common for masseter treatment)

If it's your first or second treatment

If your metabolism is slower

If you have smaller or less active muscles

The masseter muscle, in particular, is large and may respond to Botox in a longer-lasting way compared to smaller muscles in the forehead.

Why Can’t I Use My Muscles as Before?
It’s not uncommon to still feel some residual weakness or restriction in muscle movement if Botox hasn’t fully worn off yet. This can include:

Difficulty raising the eyebrows

Reduced ability to frown or make expressions (“11s”)

A feeling of tightness or flatness in the forehead

These effects can be especially noticeable if the injection was placed too deeply, diffusely, or in higher doses.

What About the “Sunken” Appearance?
Botox doesn’t add volume, but it can alter the balance of facial muscle activity, which may:

Cause subtle changes in facial symmetry

Make certain areas (like the temples or cheeks) appear slightly sunken or hollow if muscle bulk is reduced, especially after masseter injections

These effects are generally temporary, but if you feel your facial shape has changed significantly, it may be worth discussing complementary treatments such as volume restoration or supportive skincare once the Botox fully wears off.

What You Can Do:
Be patient: It may still take a few more weeks for full resolution.

Avoid additional Botox until all effects have worn off.

Gentle facial exercises (once advised by a professional) may help gradually re-engage affected muscles.

Topical treatments and skin health maintenance can help restore facial tone and brightness in the meantime.

Final Thoughts:
What you’re experiencing is uncommon, but not necessarily abnormal. Everyone metabolizes Botox differently, and it’s possible to have prolonged effects, especially in larger or less mobile muscles. The good news is that Botox is not permanent, and function should fully return with time. If you continue to have concerns, a personalized assessment may help guide the next steps.

James M. Economides, MD, FACS · Answer

It's understandable that you're feeling anxious about this situation. Typically, the effects of Botox should gradually wear off within 3 to 6 months, but it can vary based on factors like individual metabolism, dosage, and the areas treated. In your case, where it's been 8 months and the effects are still present, it's not entirely typical but not unheard of either.

Here are a few possible reasons for this:
Prolonged Effects: In some individuals, the effects of Botox can last longer than expected, especially if higher doses were used or if you metabolize it more slowly. While this isn't usually harmful, it can lead to prolonged muscle weakness in areas like your forehead and masseter muscles.

Muscle Atrophy: Over time, if Botox treatments are repeated, the muscles can atrophy (shrink) due to lack of use. This can lead to a sunken appearance, particularly in the lower face, and reduced ability to raise the eyebrows or create expressions.

Asymmetry or Uneven Results: Botox can sometimes cause subtle asymmetries or changes in facial expression that may not fully return to baseline, especially if the placement or dosage was uneven. If the forehead and eyebrows still don’t look like they did before, it may be due to this.

What You Can Do:
Consult with Your Practitioner: It's important to go back to the practitioner who administered the treatment or seek a second opinion from another experienced injector. They can assess your face, muscle function, and any residual effects of Botox.

EMG Test: Some clinics may offer an electromyography (EMG) test to assess the strength and functionality of your facial muscles. This can help determine if there's muscle weakness that needs further attention.

Physical Therapy or Facial Exercises: In some cases, gentle facial exercises might help re-strengthen muscles that have been inactive due to prolonged Botox effects. Your injector or a physical therapist may guide you through safe exercises.

Wait for Full Dissipation: Botox can take a long time to fully dissipate in certain individuals. While you may still have effects now, it's possible they will continue to wear off gradually over time.

Dermal Fillers: If the "sunken" appearance in your lower face persists and it bothers you, dermal fillers can help restore volume and balance your facial proportions. Consult with a qualified professional to explore this option if you're interested.

Managing Anxiety:
If you're feeling overwhelmed by this, it might help to have a conversation with your practitioner to better understand your situation and possible steps forward. Sometimes, understanding that this can be a prolonged but non-permanent effect can help ease anxiety.

You're not alone, and many people experience variations in Botox results. An experienced provider can help guide you through your concerns and suggest the best approach moving forward.

Camille Cash, MD · Answer

Botox effects are not permanent.  Most wear off gradually over three to four months, but it can be longer for some.  From your description it seems to be starting to wear off but isn't quite there yet.  It may be more time is needed for you.  You may want to review your "before" photos with your injector to see how much has worn off.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It's understandable to feel anxious about the prolonged effects of Botox, especially when they don't align with the typical duration you were expecting. Botox usually lasts between 3 to 6 months, so if you’re experiencing significant residual effects beyond this period, it may be unusual but not unheard of. Sometimes, Botox can linger longer in certain areas, or the results might be impacted by the dosage and placement of the injections. The lingering effects you're describing, like difficulty raising your eyebrows or a sunken appearance, could be due to the botulinum toxin still affecting the muscles or an imbalance in muscle function and skin tone. I hope this helps and best of luck!

Botox to forehead & masseter lasting for more than 8 months, is this normal?

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Botox to forehead & masseter lasting for more than 8 months, is this normal?

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Answer: Botox

Answer: Botox

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