I Do Not Have Lasting Botox Results. What Are my Alternatives?

I do not seem to have lasting effects from Botox-type injections. I do see an improvement but it typically lasts no more than a month or two, and by month three its effect has completely worn off. My problem area is the forehead, and my doctor has tried increased dosages, different brand (Dysport). Nothing. He feels that a forehead lift is not indicated (I'm in my 40s and my skin is not lax). Are there any options for me? Thank you.

Doctor Answers 18

Options when Botox results are short-lived

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Since you have already tried altering the dosage and even the product (Dysport) with your current injector, the best option is to try another injector.  Storage, dilution, injection technique and the individual patient can all be factors in the duration of Botox effect.  

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

Botox Alternatives For Short Lasting Results

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It is difficult to determine the reason you are not seeing results with either Botox or Dysport.  Some people do metabolize Botox fairly quickly. However, the technique, the number of units administered as well as the concentration of the injection solution may have played a part in the outcome you described.

As another consideration, some patients have experienced successful natural looking results with Radiesse used to correct forehead wrinkles. Radiesse does not target the muscles or nerves. It is a calcium based filler that can add more firmness to your skin. It can also promote the development of new collagen fibers as well.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

If you don’t have lasting results, it may be because you’re not getting enough product

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If you don’t have lasting results, it may be because you’re not getting enough product. Or, it may be because you have a resistance to the product (but that’s pretty rare). Xeomin, the newest neuromodulator, may be more effective in some patients who don’t respond well to BOTOX, but it may also be the injection technique and the amount of product being injected. And, some patients just respond less well to BOTOX overtime. Your options are changing the dose, finding a different injector, switching to Dysport or Xeomin, trying filler instead (sometimes using filler along with BOTOX can make results last longer), or surgery.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

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Botox in Forehead is Not Working.

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Hi NP.  Two variables would be the number of units being used and the technique.  We might suggest seeking out another injector to find out if another MD would be able to affect a different result.  

We see very few patients that metabolize Botox this quickly so it's worth trying another injector before considering surgery.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox alternatives.

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The advice you have seen here appears to all be very sound advice. Without seeing a picture and knowing how many units have been used it is hard to be more specific. However, it is possible to have the muscles causing your glabellar frown lines to be weakened surgically without doing a brow-lift. You might discuss this with your plastic surgeon. Once the muscles have been weakened by partial removal your Botox will last much longer as the dose to muscle ratio will have been substantially altered.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 116 reviews

Botox Results

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I think you have received some great advice here : check the dosage delivered by your doctor, make sure it is authentic Botox from the US company Allergan, etc. 

There has been one recent development regarding Botox. Although studying "blepharospasm" patients recieving Botox, there may be a clinical correlation to ingesting oral Zinc prior to your injection which may enhance the results. Has not been sufficiently studied, but might be something out there on this...stay tuned.

Good luck!

Dr. C


John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon

Neurotoxin not lasting long

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In a litle while there will be a topical agent available that is also a neurotoxin. This is not to be used on the forehead alone, but in conjuction with injected neurotoxin- you may see longer results.

Botox not working long enough

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It would be helpful to know how many units were injected. Unfortunately, patients tend to metabolize Botox at different rates, so Botox may not last as long in some individuals. That being said, with continued treatments with Botox or Dysport, the muscles may weaken and require fewer injections over time.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
5.0 out of 5 stars 85 reviews

Botox resistance may be a factor in inadequate treatment result

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As you have been through multiple different approaches to your Botox injections (dosage changes, different formulations) with no improvement in the outcome, it is likely that your response is as good as it is going to get. While the vast majority of patients get better and more sustained responses, there are some who get a Botox result like yours. A few patients have some degree of Botox 'resistance' and just can't get that more significant and sustained result. While I think there is merit in trying a different injector and new formulations that are forthcoming, your results may not get any better. One non-chemical approach is that of Ulthera which treats the muscles through a deep energy denervation approach.

Alternatives to Botox for glabellar frown lines in Botox non-responder.

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There are other forms of Botulinum toxin pending release by the FDA but not currently available. One example is Puretox by Mentor (now J&J). For isolated treatment of the frown lines a radiofrequency abalation to fhe branches of the nerve to the corrugators can provide long term treatment but are most costly. This is called GFX. Another option is endoscopic or trans-blepharoplasty resection of the corrugator muscles

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.