Why is my Botox Only Lasting 4 Weeks (50 Units on 33 Year Old)?

You most likely have developed Antibodies to the Botox which is rare but occurs. In our experience, 10 units will treat the glabellar lines in 90% of patients when properly injected.  The maximum recommended dose is 20 units for the glabellar area in the Botox insert.  "Distant spread of toxin effect" is being reported.

Try another product such as Dysport.  Increasing the dosage may not be prudent.

BOTOX® molecules attach to a nerve ending membrane.  They are then internalized into the cytoplasm of the nerve terminal. One molecule of Botox® then cuts one molecule of SNAP-25.  SNAP-25 is one of three molecules than must attach (docking) in order for acetylcholine to be released across the cell membrane to a muscle receptor for it to contract.

Imagine you have 10 SNAP-25 molecules in a glass.  You add ten Botox® molecules in the glass and all the SNAP-25 molecules will be cut.  Now imagine you put 100 Botox molecules in the glass of 10 SNAP-25 molecules.  You have now wasted 90 molecules of Botox®.  Some theorize that a single Botox molecule can continue to cleave more than one SNAP-25 molecule, which would be more wasteful.

At higher concentrations, cell-to-cell transfer of active Botox® has been demonstrated, which raises questions about the toxin affecting cellular targets that are distant from the injection site.

The objective is to use the least amount of Botox® that will cleave the SNAP-25 molecules in the treatment area and not overload the treatment area with wasted Botox.  Botox that may migrate to affect distant targets.

While Acetylcholine is blocked by Botox®, new nerve buds are forming.  If Botox® permanently blocked the treated nerve endings, new ones would simply grow and replace the non-functional ones.  Therefore claims, that one product is longer lasting than the others, or higher concentrations prolong the blockage, are highly suspect.  The objective is to use the least amount to do the job. 

In the early 90’s we experimented by trial and error.  We diluted a 100 unit bottle of Botox® with 10 cc of normal saline, yielding 10 units per cc which we injected using a 1cc syringe and a 30 gauge needle.  We videotaped our patients before and after for muscle function.  We decided to inject the muscle though and across muscle bellies, and across lines of innervation rather than poke them directly from above, to lessen the pain and bruising.   We observed that in over 90% of patients, 10 units of Botox® would paralyze the frown lines for over three months.  10 units of Botox® across the forehead would weaken the muscle to soften the wrinkles but avoid the “bowling ball” effect of complete loss of facial expression and forehead droop.  5 units on each side of the crow’s feet avoiding the lower lid would improve the area without lid ptosis.  We then adjusted for patients with greater or lesser degrees of muscle mass.  In five days we could evaluate the effects and adjust accordingly.  We were pioneering in those days and had to figure this out for ourselves when treatment for wrinkles was off-label.   It now seems we evolved our technique on one of the Galapagos Islands.

Botox® Cosmetic recommends reconstituting a 100 unit bottle with 2.5cc of 0.09% sterile non-preserved sodium chloride which would yield 40 units of Botox® per 1cc syringe.  

In our twenty-one year experience, this is four fold the effective dose.  It may also explain reports of effects and complications beyond the site of injection.  Advances in immunostaining techniques reveal active Botulinum A can migrate cell to cell in high concentration. (jneurosci.org/content/31/44/15650.full.pdf).   We have just scratched the surface of understanding Botox®.

Perhaps our technique improves the effectiveness of our dosages, but we had similar results with the more common stabbing technique, which we also tried.  We encourage intellectually curious colleagues to experiment and find the lowest possible dosage that saturates the nerve endings and accomplishes the mission without wasting molecules of Botox® that are yet to be fully understood and may migrate to sites beyond local injection as noted in the warning label.

Thank you for your question and concern. I train a lot of injectors in the proper technique for Botox injections. Here are some of the common reasons that Botox wears off too quickly:1) Inadequate dose - higher doses usually corrects the problem2) Cookie cutter approach to injecting Botox. The same technique is used for every patient and it works for most, but not all patients. The cookie cutter approach fails to appreciate the differences in anatomy of the facial muscles that can vary by the individual.3) Rarely, there are patients who truly have shorter durations with Botox and may want to consider the different neuromodulators available to see if there is a difference. I would recommend that you go an experienced board certified plastic surgeon or dermatologist who does a high volume of injectables to discuss your experience in more detail.

It is most likely the amount used for the specific area that makes the botox appear as it is “worn off.” The peak effect of botulinum toxin is 2 weeks, and from there new nerve endings start to sprout to regain normal activity, but wrinkles from movement take about 3 months to be seen again (if the right amount is used to begin with) and full movement typically comes back shortly thereafter.  Antibodies can occur, although usually in those who have had large doses used for other indications (ie: cervical dystonia, muscle spasms, etc) for a long period of time.  I would consider seeing a board-certified Dermatologist or Plastic Surgeon for a second consultation and treatment.

The amount of time Botox lasts will not be related to exercise. In general, the Botox lasts for 3 months on average. If you do not feel that the Botox is lasting long enough, you may want to ask your provider about Dysport. It has a faster onset than Botox and lasts slightly longer. I hope this helps, and best of luck to you.

Depending on placement and technique, this has been know to happen for some people, a shorter efficacy than what's expected for cosmetic Botox. Sometimes we recommend trying a different neuromodulator - or waiting a little longer between treatments to avoid potentially building up a tolerance to the product.

I always tell patients that a unit of BOTOX is kind of like a milligram (mg) of ibuprofen.  For example, let’s say you have a headache—some individuals can take 200mg of ibuprofen and the headache goes away.  Others may have to take 800mg of ibuprofen before they have relief from the headache.  BOTOX is similar—some patient’s frown lines respond well with 25 units of BOTOX—whereas others may need closer to 50 units to achieve a pleasing result.  Men typically require more Botox then women.  You must remember that Botox is dose dependent and if stored correctly, mixed correctly and dosed appropriately, it should last close to 3 months.

 

Recommendations: 

1)  Seek a  different provider.  I would advise you to make sure you are going Board Certified Physician's office to consult with them about your past experience with Botox Cosmetic.

2) Find out what dilution ratio is being used. I prefer a 1:1 ratio in my practice. 

3) Beware of daily deals from online marketing emails.  These tend to not make much sense when it comes to cost consideration and may not be all that they are promised to be.

This sounds unusual.  First of all, 50 units is much more than what most board certified physicians would inject for frown lines.  Secondly, if fresh, properly stored, and properly diluted preparations of Botox are used, it should last more than 4 weeks.

 

You may want to try another Botox administrator/clinic/office to see if that makes a difference.

50 units is twice the standard dose for treating the glabellar frown lines, and should certainly last more than 4 weeks.  A number of variables could be at play, including reduced Botox activity due to improper storage and handling.  Trying another office may be the best way to single out the issue.  

Hi Missmenag.  The issue could be you, but more likely it's the product or the technique.  It's possible that the practice you are going to is storing the product incorrectly which is leading to it being less effective.  It could also be that this practice is purchasing from overseas and the storage/shipping procedures of the seller may be inadequate.

In either case, we would suggest trying a new office.  50 units is way too much for the area between the eyes and it should not be wearing off before 3 months.  Good luck.

sorry to hear about your short duration of botox activity...the usual culprits include not getting 50 units but much less, improperly stored botox that was left at room temperature for too long, counterfeit product that really wasn't the botox or some resistance your body has to the product...remember botox doesn't work on everyone...botox works at a specific site...if you have an abnormality of the gene encoding the area where botox works, then you may be resistant to the product...the idea that your body makes antibodies that cancels the effects is old, outdated and not of clinical significance...the running may be an issue but will not totally explain the situation...finally do you have before and after pictures...often you may still have an effect that you're unaware of without the advantage of side to side pictures...maybe next time try a different doctor and see if the results are the same