Why does 2:1 botox not last as long on me as 1:1 ratio does even with same mumber of units (actually used more with the 2:1)?

Question

Ive been getting botox for quite a while. Ive tried dysport and it just felt too frozen. I have hooded eyelids and droopy brows. For some reason that gives me chronic migraines and when I get botox to lift my brows it helps dramatically and wont have a single migraine for at least two months. My injector moved away and Ive tried a few others all who use 2:1, mine used 1:1 and way less units. I keep being told to take zinc though my zinc levels are high (tested) or that I am immune to it now though it works fine in my chin and dao etc.. but I always worry the higher the dilution the worse it will be for my hooded lids and droopy brows since it spreads more. I dont get botox in frontalis bc it completely flattens my brows (no matter how high or low they inject) and causes severe pain into my neck and jaw etc. Anyway now that I am getting 2:1 with almost double the units the botox only lasts two weeks in my procerus and corrugators. Could it be the dilution ratio??

A.J. Amadi, MD · Answer

Reconstituting Botox at 1:1 versus 2:1 changes the concentration and injection volume, not the strength of the toxin. A 1:1 dilution is more concentrated, so less volume is injected for the same number of units, allowing for more precise placement. A 2:1 dilution contains more saline, so a larger volume is injected to deliver the same units, which can create slightly more spread and softer blending in certain areas. In other words, some nurse injectors dilute a 2:1 in muscles that are larger where they want more spread of product. Both reconstitution styles should last you the 3-4 months. Keep in mind that doseduration so the higher the dose, the longer it will last.

Your frontalis (forehead muscle) is an elevator muscle so when we put too much botox in this area, it can weight down our forehead and cause us to get "heavy." Some patients who have a larger forehead/or someone with eyelids that aren't hooded can be injected with more botox in their forehead.

You should ask your old injector for a past "facesheet" to show to any new injector so that they can follow that same process if you have liked your results in the past- I have had a lot of my patients do this.

Anna Chacon, MD, FAAD · Answer

Hi,

What you’re experiencing is actually not uncommon, especially with different dilution ratios and injection techniques. When Botox is more diluted—as in a 2:1 ratio—the solution spreads more, which can be useful for larger muscles but sometimes reduces the duration of effect in smaller, targeted areas like the procerus and corrugators. Even though more total units are used, the concentration at the muscle itself is lower, so the effect may wear off faster.

Your experience with a 1:1 ratio and fewer units likely gave you a more precise, longer-lasting lift in the brow area, which explains why your migraines were effectively prevented for two months. Dilution and injection placement are critical in areas with hooded eyelids or droopy brows, because small differences in spread can change the lift and duration dramatically.

Being “immune” to Botox is very rare, and your response in other areas like the chin and DAO shows that your body still responds. Zinc supplementation generally doesn’t influence Botox duration, so if your levels are normal, that’s unlikely to be a factor.

In short, yes—the higher dilution (2:1) could very well be why the effect in your brow area is shorter, even with more units. Targeted injections with the right concentration are usually the key to maintaining both duration and the subtle brow lift you need for migraine relief.

Camille Cash, MD · Answer

The dilution may be making the injections a little less precise, meaning the product may be spreading a bit more than it did with the lower dilution/higher concentration.  This could alter your results some, though it should still last longer than two weeks.  I encourage you to speak with your injector about your concerns.

Why does 2:1 botox not last as long on me as 1:1 ratio does even with same mumber of units (actually used more with the 2:1)?

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