Why Is My Botox NOT Working?

I started Botox injections in June of last year. My initial injection was 40units. I was ecstatic to say the least! It lasted almost '4' months! However i went for my next injection and got 26 units. I was not happy with the results but I waited it out for 2 months and then went back. In Dec I received another 24 units. It that still did not yield a pleasing result. Went back in Jan... 24 units, back in Feb...26 units and in April 33 units. Is it being over dilluted? $1100 in 4 months! What!

Doctor Answers 10

40 units

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40 units may be what you need. I suggest you see the injector who gave you the initial 40 units because you liked your results then. 

Botox units, how many is right for you

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You didn't qualify if each time the same area was treated but assuming it was, it doesn't make sense to treat you with less units in the same area if you had a great result the first time. Adding more units before it all wears off to try to make it right is never the same as treating you from "scratch".  I would advise you to wait until it all wears off, see the same provider and have the same treatment you had initially that you liked.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox NOT Working

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If you were pleased with 40 units, then you may need to maintain that level for correction.  Clarify with your injector why he/she decreased the amount. Botox efficacy is affected by the technique of the injector, the amount of botox used, and the storage of the product.

Botox not lasting

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If you had 40 units initially and you were ecstatic with the results, why not insist on 40 units each treatment?  When a perfect result is achieved, treating with fewer units at future units only leads to frustration.  Stick with the formula that works so you can get consistent results every time.

Botox not lasting long enough

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I am not sure why your physician decreased your dose of Botox, after you were pleased with the first treatment. You should probably ask your treating physician why he/she decreased the amount that was injected. In my experience, Botox produces very consistent results. After I treat my patients with Botox, I recommend they come back to see me in 2 weeks in case a small touch-up is needed. Rarely are touch-ups necessary, but this ensures that all of my patients are pleased with their outcomes.

Ryan Greene, MD, PhD
Fort Lauderdale Facial Plastic Surgeon
4.9 out of 5 stars 83 reviews

Botox units and effect

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It may be that you require more units to achieve the desired effect and you may wish to discuss this with your surgeon and ask them to use what worked best initially for you. Typically, I find there is a standard amount of units but there are some patients who require higher and others who require lower doses. Good luck.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews


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Botox can do wonders for different people.  I do not specifically go by units, I go by areas that I need to treat whatever that may be.  Usually the amount of units is similar in each specific area, but can vary depending upon the patient's needs.

Botox Dose

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If 40 units worked well for you, then why would you decrease to 24 or 26 units.  I am not understanding the logic of what happened.  Botox should last anywhere between 3 to 5 months depending on your metabolism.  Subsequent treatments require the full dose again, not partial treatments like you had.  Additionally, 24 units is a drop in the bucket.  Most patients require closer to 50 units to achieve a nice result.  If you try 40 or 50 units again and do not have a nice response, then you may want to try other brands such as Dysport or Xeomin.  Or other subtypes such as Myobloc.  Our office stocks all 4 brands and usually one will work well.  In a small percentage (0.01%) you may develop antibodies to the Botox molecule which will make you immune.  However, from your story, it sounds more like under dosing than any immunity issues.


Good Luck.

Botox units matter

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It seems that the 40 units worked well, and your doctor is now doing low dose frequent injections.  Have you spoken about this with your practioner?  I have many patients who love low dose frequent injections since its very natural looking, but it doesn't last as long, and depending on the strength of your muscles the dose may not give you 100% results.  If you prefer the results from 40 units, just do that amount.  Sounds like to need to discuss with your doctor, or find a new injector.  I doubt you have developed antibodies to botox so quickly and anitbodies are extremely rare. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 28 reviews

Botox not working

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It sounds like your initial dose of Botox was adequate for your needs.  The subsequent dose may have been too small or you could have developed antibody sensitivity that is breaking down the Botox before it has an effect.  You might try using a different brand, such as Dysport or Xeomin as they have a slightly different chemical structure.  In blepharospasm patients that become tolerant to Botox, we use botulinum toxin type B or Myobloc, but I've never seen it used cosmetically.

Matheson A. Harris, MD
Salt Lake City Oculoplastic 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.