Can I receive a Botox touch up before the recommended two weeks, if so what are the risks?

Question

I’m a regular user of Botox and just saw a new provider/new office. During the consult I told her I’ve always had 28-30 units for the glabella/forehead lines. She insisted on doing only 14 even though I’d always been very happy with my usual. I listened to the provider and got what she said. Upon thinking about it, I didn’t get what I asked for, I asked to come back the next day to get the additional 16u. They’re fighting me on this? Would it be ok cosmetically to retouch after one week?

Paul Vitenas, Jr., MD · Answer

Thank you very much for your question. It sounds like your new Botox provider may have been using a conservative approach during the first appointment. As it takes one to two weeks for the results from your Botox procedure to become apparent, the best advice is to wait the full two weeks before getting a touch-up. This will give your provider a chance to assess the final results and apply the right amount during your touchup to reach your aesthetic goals.

Rod J. Rohrich, MD · Answer

One should wait at least 10 days under normal circumstances.  But in your case, since you routinely get injections and know the number of units you usually get, it is not out of the question, nor would it harm you, to get more in a week's time.  However, as noted, you may have a hard time convincing your injector of this.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  I would always recommend waiting a full 2 weeks before a touch-up in the same area previously treated as this ensures a more predictable outcome rather than "stacking" on top of another.  Hope this helps.

Theresa M. Jarmuz, MD · Answer

You want to wait the full two weeks because it can take up to two weeks for full onset of Botox. If you retreat too soon, you may end up with a frozen look.  With regard to the amount, you new provider may be using a more concentrated reconstitution and therefore they would use a lot less. 
It sounds like your new injector has your best interest in mind.

Gordon Andan, MD · Answer

Hello, I can certainly appreciate your concern. Because the results of BOTOX injections can take up to two weeks to fully develop, it’s usually recommended that you wait at least this amount of time before getting any additional injections, even if you’ve had BOTOX before. You still do run the risk of ending up with an over-injected and unnatural appearance if you have additional injections done before the first round is able to fully settle and show results. If you’re still unhappy with your results around the two-week mark, you could discuss the possibility of compensation on your second round at that point, without risking a botched job.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question melissajym. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
If I had a patient with the concern described here I would recommend waiting a full two weeks after the treatment before receiving additional units. This allows the product to completely kick in. At that time it can be best determined where and how much additional units should be added if necessary.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Yvette Tivoli, DO, FAAD · Answer

Thanks for your great question! Your new provider of Botox neuromodulator appears to have taken a conservative approach with the number of units to treat the intended areas.This was done with your best interest in mind. Touch ups are usually done at two weeks because the onset of action for Botox can take up to 2 weeks and to inject before can risk getting too many units which can result in unwanted side effects or a frozen look. Once the neuromodulator is injected it cannot be removed and of course more units can cost you more. If at the two week follow up you find that the units used to treat the intended area have give you the outcome you desire then you can consider it a cost savings as well.

Carmen A. Traywick, MD, FAAD · Answer

Everyone has unique expressions. We move our facial muscles in a repetitive way and over time those repetitive movements cause wrinkles and fine lines. When you start to experience the signs of aging, Botox are available to diminish unwanted wrinkles and creases in your face.Botox  locks the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox, essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. It sometime can take a full 2 weeks before Botox has effect. It would be best to follow up with your injector at 2 weeks to discuss any questions or concerns that you may have. Hope this helps.

Jean M. Casello, MD · Answer

It usually takes 2 weeks to see the full effect of Botox.  Your provider was probably being conservative since it was the first time that she had injected you. You should wait the full 2 weeks and than have it adjusted at that time. As always you should feel comfortable with your provider, otherwise look for a new injector.

Michelle Ellern, DO · Answer

I would wait and see what sets in and then add any after 10 days. Better to do too little and add more. You can't remove too much botox. It is hard to say what you need without an exam. If you are unhappy with your results find a new provider that you can work with and trust.

Can I receive a Botox touch up before the recommended two weeks, if so what are the risks?

Answers (14)

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