Does Botox wear off unevenly? (photos)

Question

My eyes are distinctly 2 different sizes. Is it possible my Botox has worn off unevenly? Or is it just a coincidence and something else is wrong? My eye more closed feels heavy.

Constantino G. Mendieta, MD · Answer

Hello, and thank you for reaching out to us.It may wear off even or uneven. It may accentuate the asymmetry that naturally exists in all of us. Working with your board certified surgeon or expert injector to discuss adjustments to your treatment plan is recommended to help perfect your treatment and recovery plan.Good luck, please let us know how it goes.-Dr. Constantino Mendieta

Thomas J. Walker, MD, FACS · Answer

Botox and other neuromodulators such as Xeomin or Dysport can indeed wear off slightly unevenly although that is not a common phenomenon but definitely possible. If that is something that bothers you, though, a minor touch-up with a neuromodulator may be done on the affected side or you may get re-treated on both sides. Best wishes!

Edward E. Dickerson, IV, MD · Answer

It is possible fore Botox to wear off unevenly. I recommend you to see your injecting physician to go over before and after pictures to see if there was any asymmetry prior to getting Botox. We are not symmetric, procedures may enhance any underlying asymmetries that went unnoticed before. Botox typically lasts for 3-6 months, so in time you will know if the asymmetry was preexisting.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question mlburnett. Most people enjoy the results from their Botox treatments for three to four months. And sometimes it wears off faster in one area of the face than another. Be sure to take photographs both before and after a treatment. Sometimes a patient notices a change after a treatment but when we look at her pictures before the treatment it looks the same. This is because when we notice something in the face sometimes we overlook or don't notice another thing. When the first issue is corrected, then another one becomes more noticeable. It is also important to remember that the two sides of the face are not perfect mirror images, so some asymmetry is normal and actually desirable. I recommending following up with your doctor to review your photographs and for specific recommendations. Good luck!

Suzanne Bruce, MD · Answer

Great question! It's certainly possible for BOTOX to wear off at varying rates across the face. There are other possible explanations for what you're experiencing, too. As other doctors have suggested, it's possible that you're noticing an existing asymmetry now that you're paying more attention to this area of your face. BOTOX can also exacerbate asymmetries like this. It really depends on where you had the BOTOX. In any case, this change is unlikely to be permanent. If you see these changes enduring past the 3-month mark, see your injector.

Millicent Odunze Geers, MD, MPH · Answer

It is possible fore Botox to wear off unevenly. Evaluation of your "before" Botox photos taken with the same lighting, same facial expression, and same position as your "after" Botox photos will give you a better of idea of whether or not you had preexisting asymmetry. We are not perfectly symmetric. Sometimes procedures make us more aware of our underlying asymmetries that were present before but we just didn't notice because we weren't scrutinizing our appearance as closely. Good news is that by 6 months, you'll have your answer as the Botox should have worn off by that time!

Kimit Rai, MD, FRCS(C) · Answer

the concentration of botox and number of units injected will determine the effectiveness of botox2 it is also dependent on where it is injected3 technical ability of the injector also has some value 4 duration of effect is dependent on concentration and number of units injected

Steven F. Weiner, MD · Answer

It is hard to say if this is Botox related or just an underlying asymmetry that is being noticed. Botox can wear off asymmetrically but that is usually related to injections which were initially asymmetric. We have have a big side and a little side, or a good side and a bad side. This is just probably related to that.

Shaun Patel, MD · Answer

The photo is limited but I get the sense that you have worse eyelid laxity on the left eye than the right eye. While it is possible that the Botox has worn off more on the left side, it is more likely that at baseline you have some asymmetry that the Botox helped even out. I would discuss your concerns in-person with an experienced injector.

Cody A. Koch, MD, PhD · Answer

The effects of Botox can be uneven based on injection technique, number of units used, placement of injections and diffusion of the medication.  If it was uneven from the beginning then it will be uneven at the end as well is normally how I think of it.  The maximum effect is at 2 weeks and if it is uneven then I ask patients to return for a touch-up to make it more symmetrical.  I usually don't see it wear off unevenly to the point of an obvious difference; however, that is not to say it can't.  Another possibility to consider is that we all have small asymmetries about ourselves. If you look closely at anyone one brow is higher than the other, one ear lower, etc.  Sometimes we don't notice those things about ourselves until we look closely after a Botox injection or facial surgery.  The good thing is that if you aren't happy with the result it is wearing off and you can start from scratch if you choose to have Botox again.Best wishes,Cody Koch

Does Botox wear off unevenly? (photos)

Answers (13)

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